NJRC New Jersey Opioid Addiction Report: A Modern Plague

NJRC New Jersey Opioid Addiction Report: A Modern Plague

TRENTON—Yesterday, Tuesday, September 25 at the New Jersey State House, the New Jersey Reentry Corporation (NJRC) released the New Jersey Opioid Addiction Report: A Modern Plague, which relies upon national “best practices” to provide for a clinically driven addiction treatment system that enshrines a “continuum of care” premised upon successful state templates.

Endorsements and statements of support:

Dr. Gail D’Onofrio, Professor and Inaugural Chair of Emergency Medicine, Yale School of Medicine:

“I am excited to review REENTRY: New Jersey Opioid Addiction Treatment Report. This comprehensive initiative will improve the health of many individuals with opioid use disorder.  Offering access to treatment with buprenorphine and methadone, both opioid agonists, has the potential to reduce overdose, all-cause mortality, HIV transmission, other infectious diseases and interactions with the judicial system. Individuals in treatment can strengthen their community.”

 

Dr. Robert Eisenstein, Interim Chair of Emergency Medicine, Rutgers – Robert Wood Johnson Medical School; Dr. Renee Riggs, Vice Chair, Rutgers – Robert Wood Johnson Medical School:

“The emergency department is on the front lines of the current opioid epidemic. We, as emergency medicine physicians, are grateful for any effort waged to combat this epidemic. It is important that integrated services to overcome addiction are provided to help our patients affected by this current health care crisis.”

 

Dr. David R. Gastfriend, lead researcher, American Society of Addiction Medicine’s (ASAM) Criteria for patient treatment matching. At Harvard Medical School and MGH over a 25-year span, he was Director of the MGH Addiction Research Program and founded the MGH/McLean Hospital Addiction Psychiatry Fellowship:

“Opioid overdoses will kill as many as 3,000 in New Jersey this year. How do we stop this tragedy? The New Jersey Reentry Corporation (NJRC) has developed a definitive plan. This report lays out the scientific basis of opioid addiction, best practices for clinical treatment, and a design for fundamentally restructuring the New Jersey addiction treatment system.

The New Jersey Opioid Addiction Report: A Modern Plague digs deep both in its research and detailed recommendations for realigning the addiction treatment system for the 21st century. As the lead researcher for treatment matching according to the American Society of Addiction Medicine (ASAM) Criteria, I was privileged to serve as the chief architect for ASAM’s standard software implementation for patient assessment and managed care utilization review. The NJRC report details the essential requirements for success in this crisis, including: ASAM’s continuum of care (consistent with patients’ clinical needs), Medication-Assisted Treatment, navigators to coordinate local service providers to facilitate patient needs, peer support/recovery coaching, a health information exchange (HIE), and comprehensive longitudinal evaluation.

New Jersey families lost 2,221 loved ones to overdose death in 2016, 42 percent more than in 2015. The state now has some of the least expensive and highest purity street heroin in the nation. Worse, this heroin is increasingly laced with or replaced by the even deadlier fentanyl. The epidemic has now severely impacted every region and every county in the state. Those most at risk for overdose death are our citizens who are returning from incarceration. While we hope that jails and prisons stabilize their recovery, what really happens is that their risk actually mushrooms – to as much as 130 times the death rate of the general population.

NJRC’s report explicitly tells us how to stop these deaths. No one whose child or partner needs addiction treatment has found it easy to get that care. New Jersey must now take these measured and responsible steps to address the inefficiencies, haphazard, and often arbitrary nature of the present addiction treatment delivery system.

The NJRC report has scoured the nation for best practices. We know what works and what will work. The New Jersey opioid crisis requires a rigorous and accountable restructuring of the treatment delivery system, according to the best available scientific and clinical expertise. “

 

Congressman Patrick Kennedy, Founder, The Kennedy Forum, a national non-profit addiction research foundation:

“Substance use disorders are chronic brain diseases that can’t be treated through episodic interventions. The New Jersey Reentry Corporation proposed model of care represents consideration of the long-term through its woven in support services and emphasis on community. This creates for the flexibility needed to foster sustained recovery, while not losing sight of best practices and evidence-based treatment, such as peer support and MAT combined with therapy. I am pleased the program is mindful that MAT cannot be approached through a one-size-fits-all perspective. Appropriate MAT treatment occurs when licensed providers are not boxed into using only certain medications but are able to assess the full array of FDA-approved options available when treating each of their patients.”

 

Dr. Douglas B. Marlowe, National Association of Drug Court Professionals (NADCP):

“Dear Gov. McGreevey:

Thank you for the opportunity to review the recommendations in your upcoming report from the NJ Reentry Corporation, New Jersey Opioid Addiction Report: A Modern Plague. The damage wrought by the opioid epidemic nationally and in New Jersey is tragic and well documented, yet effective policy responses have remained largely elusive. As a senior scientific consultant for the National Association of Drug Court Professionals (NADCP), I have personally witnessed the devastating effects of opioid addiction on persons involved in the criminal justice and child welfare systems. I strongly endorse the treatment- and prevention-focused recommendations in your report, which if implemented I believe would make major contributions to public health and public safety.

For too long, the substance abuse treatment system has applied a costly and ineffective acute care model to address the chronic and progressive neurological disease of addiction. Third party payers, whether public or private, typically approve only brief 28- or 30-day treatment regimens, when research clearly shows that 90 days is a minimum threshold for achieving therapeutic benefits from treatment and 6 to 12 months is often required for lasting recovery. Treatment agencies have largely oriented their programs around this ill-advised funding structure, leading to costly revolving-door treatment admissions that often produce lackluster results.

As you ably discuss in your report, the majority of treatment programs also continue to neglect or reject life-saving medications proven to alleviate painful withdrawal symptoms and drug cravings, reverse life-threatening overdoses, reduce crime and illicit drug use, and restore families. The situation is even worse in the criminal justice system, where 50% to 80% of persons suffer from a serious substance use disorder and often a co-occurring mental health disorder as well. At most, only about 5% to 10% of these highly vulnerable individuals receive anything remotely resembling effective or evidence-based treatment, let alone proven medications.

I strongly endorse the recommendations in your report to instill medication-assisted treatment (MAT) as a central component in a hub-and-spoke treatment model throughout New Jersey. Combined with continuing-care and wrap-around services lasting 6 to 12 months and provided in participants’ community of-origin, this proposed model adheres closely to the scientific evidence, has already shown evidence of success in other states such as Vermont, and promises to marshal New Jersey’s treatment resources most efficiently, reduce unnecessary correctional expenditures, and save thousands of lives.

I wish you every success in your efforts to move this critical agenda forward, and look forward to reviewing the results of your demonstration projects. If I can be of further assistance to you or your colleagues, please consider me as a resource.

Respectfully,

Douglas B. Marlowe, J.D., Ph.D., FCPP”

 

Dr. Ali Raja, Executive Vice Chair and Associate Professor, Emergency Medicine at Massachusetts General Hospital and Harvard Medical School:

“As an emergency physician, I experience the devastation wrought by the opioid epidemic on a daily basis. My patients have inspired me to join forces with my colleagues, community partners, and state leaders to help turn the tide on the opioid epidemic here in Massachusetts. The hospital where I work, Massachusetts General Hospital (MGH), has become a leader in curbing inappropriate prescribing of opioids and initiating medication-assisted treatment for those caught in the throes of active addiction.

Our work has given me a firsthand appreciation for the real, tangible difference that best practices in treating addiction – including increasing access to medication-assisted treatment, access to longer-term treatment options in the community, and health information exchanges – can make in the lives of our patients. This report by New Jersey Reentry Corp (NJRC) brings these principles into sharp relief.

I wholeheartedly support their efforts and fully endorse their call to action.”

 

Dr. Mark Rosenberg, Chair of Emergency Medicine, St. Joseph’s University and credited with developing the ALTO Protocol, which is aimed at curbing opioid prescribing in the emergency room and the basis of bills in the state legislature as well as Congress:

“This is a comprehensive report outlining the opioid problem in the United States and in New Jersey. It not only outlines the problem, but it addresses the three major parts of the opioid epidemic solution, prevention, treatment, and harm reduction.”

 

Dr. Ramon Solhkhah, Chair of Psychiatry, Hackensack Meridian Health:

“The report that NJRC is putting out today highlights the need for health systems to act.  The opioid crisis is unprecedented in its scope and intensity and we are implementing robust strategies to provide genuine solutions,’’ said Ramon Solhkhah, M.D., Chairman, Department of Psychiatry at Jersey Shore University Medical Center. “Hackensack Meridian Healthis expanding capacity, adding psychiatry residencies and merging with Carrier Clinic which will result in greater care coordination and increased access to treatment, including the opening of a new addiction treatment center next year.’’

 

Dr. Arthur Robin Williams, addiction specialist and Assistant Professor, Columbia University Irving Medical Center:

“There has long been a quality chasm among addiction treatment programs. In the context of the opioid epidemic, the death toll and costs to society have begun to skyrocket. New Jersey Reentry Corp is to be commended for highlighting evidence based medical approaches and effective systems of care for treating opioid use disorder.”

 

Dr. Jill Williams, Addiction Specialist, Professor of Psychiatry at Rutgers, and Director of the Division of Addiction Psychiatry, Rutgers – Robert Wood Johnson Medical School:

“I applaud the work being done by the NJ Reentry Corporation to address the senseless and staggering deaths of so many New Jersey residents from the opioid crisis. More certainly needs to be done to address the complex mental health needs of people with opioid use disorder who have high rates of anxiety and depressive disorders, and to provide Medication Assisted Therapy more uniformly in the addiction treatment system. As this report points out, an integrated approach is urgently needed to coordinate addiction treatment in NJ and we must act today, before more lives are lost.”

 

Dr. Erin Zerbo, addiction specialist and Assistant Professor, Rutgers – New Jersey Medical School:

“Governor McGreevey, Dr. Aakash Shah, and the entire team at New Jersey Reentry Corp have done us all a great service by compiling such a comprehensive guide to effective models across the country for the treatment of opioid use disorder. In the midst of the frenzy of this opioid crisis, we need a calm and clear-eyed look at which policies have actually been effective. This report provides a crystal clear look at the data, and suggests a number of crucial steps that we can take to get a better handle on this epidemic in the Garden State. I commend New Jersey Reentry Corp for this contribution and I hope that our legislators and our healthcare leaders will use this information to improve access to medication-assisted treatment and to build better organizational hierarchies to combat this crisis.”

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