To Defeat Opioid Addiction, N.J. Doctors Must Stop Over-Prescribing

Elaine Pozycki, PDFNJ Chair, is dedicated to raising awareness on the links between prescribed opioids and heroin abuse rates. Her letter to the editor in today's Star Ledger focuses on the newest legislation passed to bring safer prescribing to New Jersey and the nation. PDFNJ will host a safer prescribing Do No Harm symposium on Monday, June 12th, and I invite anyone who is interested in learning  more on this topic to register to attend here.



To defeat opioid addiction, N.J. doctors must stop over-prescribing | Opinion

By Elaine Pozycki 

If we're going to beat the opioid epidemic -- nationally and here in New Jersey -- it's going to be a the doctor's office.

Former U.S. Surgeon General Vivek Murphy's put it simply when he said our doctors, nurses and other healthcare providers are "the first line of defense in the battle against addiction."  

New Jersey's recently adopted comprehensive law to combat opioid addiction, incorporating common sense measures that Partnership for a Drug Free New Jersey, addiction experts and impacted families have long advocated, sets the table for prescribers to become an active part of the solution. Taken together, these measures give New Jersey among the strongest, if not the strongest set of opioid prevention laws of any state in the nation.

This new law takes on the opioid epidemic at the source: the over-prescribing of opioid based painkillers.  

It limits initial prescriptions to five pills and mandates all prescribers receive ongoing training in current best prescribing practices as a condition of being allowed to prescribe opiate based painkillers. 

The new law also requires a conversation between all patients and their doctor before an opiate is prescribed about the risks of addiction and potential alternatives. This requirement for a conversation before an opiate is prescribed expands to all patients the provisions of a recently adopted law targeted specifically at the parents of children and teenagers.

Maximizing the positive impact of this new law, however, requires the medical community to embrace its spirit and put its provisions into practice.  That is why the continued resistance of the Medical Society of New Jersey, which opposed the legislation, is disappointing. 

Contrary to Centers for Disease Control and Prevention (CDC) and other medical and addiction experts who understand that the main cause of the current epidemic is over-prescribing and as a result emphasize the need to employ alternative non-addictive treatments -- which for most kinds of pain are just as effective as opioid-based pain relievers -- the Medical Society of New Jersey is stuck in the old paradigm. Chief Operating Officer, MishaelAzam recently said, "Since the CDC guidelines were released and (S3) was signed, patients feel like criminals for needing pain medication."

In a state and nation where 4.59 million prescriptions and 216 million prescription respectively were written for opioid-based pain relievers last year, the problem I respectfully submit is not under-prescribing.

Despite some welcome modest reductions in the number of prescriptions issued each year, it remains over-prescribing.  I recognize that there are cases where using an opioid-based pain-reliever is appropriate, particularly for some post-operative patients and in hospice care, but we are still a long way from  these highly addictive medications only being prescribed when necessary.

It is important to keep in mind that research demonstrates that people who abuse or are dependent on prescription opiate painkillers are 40 times more likely to abuse or be dependent on heroin. And a recent University of Michigan study showed that high school students who use prescription opioids, like OxyContin, Vicodin and other pain relievers, are 33 percent more likely to abuse opioids by the age of 23.

And we feel the impacts of the old ways of prescribing every day in our state. More than 100,000 New Jersey residents are already addicted to prescription opiates or its illegal street cousin, heroin. More than 5,000 people have died from overdoses in our state in the past decade alone. And the overdose antidote, Narcan, is employed more than 20 times a day.

Fortunately, despite the attitude of the Medical Society, there are doctors, nurses and medical practitioners throughout New Jersey stepping up and embracing current best practices. One encouraging example is a ground-breaking pilot program, Alternatives to Opiates (ALTO) underway at St Joseph's Regional Medical Center Emergency Room. This successful program demonstrates that most patients can be given effective pain relief without the use of opiates. 

So far, three-out-of-every four patients needing treatment to reduce pain were successfully treated by alternative medications and therapy, forgoing the use of highly addictive opioid-based painkillers.

I urge the Medical Society of New Jersey to turn the page and embrace and publicize efforts like the ones at St. Joseph's and proactively educate all New Jersey Doctors on how they can affirmatively implement the provisions of the new law to become an active part of the solution to our opioid epidemic.

That would be a real public service, paying off in saved lives.

Elaine Pozycki is Co- Chair of Partnership for a Drug-Free New Jersey.

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