By Ken Serrano
Asbury Park Press
Racked with heroin addiction more than a decade ago, Morgan Thompson loosened the unrelenting grip of opioids with the help of programs like a sober-living student housing arrangement at Rutgers.
Thompson, 31, is now married, a mother, and the CEO of Prevention Links, a drug prevention and recovery support non-profit – the sort of organization that helped save her.
The expansion of community support programs like that Roselle-based center represents a shift from the way New Jersey handled addiction five years ago, recovery experts say. The trend in drug overdose deaths in New Jersey suggests those and other efforts have paid off as the nation faces a mounting crisis.
Unlike much of the rest of the country, New Jersey’s drug overdose deaths have been nearly flat for three years, from 3,006 deaths in 2018, to 3,021 in 2019 and 3,046 in 2020, according to NJ CARES, run by the state Attorney General’s office. The figures for the past two years, listed as suspected drug deaths, have yet to be finalized.
At the Shore, Monmouth County’s drug overdose deaths stood at 215 in 2018, 187 in 2019 and 186 in 2020. Ocean County’s figures were 219, 204 and 245, respectively.
New Jersey’s drug deaths are still staggeringly high — 2020’s toll was a record — compared to 2012 when 1,223 people in New Jersey died from a drug overdose.
Nationwide, fatal drug overdoses rose by 28.8% from the 12-month period ending September 2019 to the year ending September 2020, according to the Centers for Disease Control and Prevention.
There were 87,203 reported fatal drug overdoses through the year that ended in September of last year (another 2,800 were suspected) up from 68,757 in 2019. When the pandemic hit, overdose fatalities spiraled upward much worse than ever before, those statistics show.
Some experts view the recent statistics from New Jersey with skepticism.
During the pandemic, the sheer number of deaths overwhelmed medical examiners around the country, possibly leading to the misidentification of the causes of deaths, said Frank Greenagel, an addiction counselor and lecturer at Rutgers School of Social Work.
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But Greenagel acknowledges that things have changed in New Jersey for the better — a big step from five years ago when he stood out as one of the most vocal critics of the way the state was handling the heroin epidemic.
“There’s a lot to be proud of,” he said. “We’ve seen a lot of positive changes.”
But have those changes actually kept the death toll down?
“I want another year or two before I’d be willing to give that one up,” he said, to see if the statistics get revised upward when drug overdose deaths in New Jersey are confirmed.
Community-based peer support programs like the one Thompson runs allow people to continue with recovery after leaving in-patient settings.
“It’s a real shift because you hear these stories about people going into detox programs over and over again, six, seven, twelve times within very short periods of time,” Thompson said. “And that revolving door of treatment that we hear about does not prepare someone to engage in a healthy substance-free” life.
Those centers link people with services like housing, employment help, counseling, continued treatment and other services not fully dealt with in a residential treatment center – an integral part of a continuum of care, Thompson said.
State-funded centers operate in about a dozen counties in New Jersey, whereas five years ago there were two funded by the state, Thompson said.
Other developments have helped New Jersey to keep the death toll from climbing.
More treatment beds
The number of individuals who went into residential treatment rose by 68% from 2016 to 2019, according to the state Department of Human Services.
At least 120 more outpatient sites have been licensed, bringing intensive treatment closer to home for patients in New Jersey, said Ellen Lovejoy, spokeswoman for the department.
The drug overdose antidote naloxone has also played a role.
“The first thing we’ve done right was to expand access to naloxone,” Thompson said.
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Doses or administrations given out by law enforcement officers and medics have risen from 7,227 in 2015 to 14,437 in 2020, according to NJ CARES, although the latter figure does not accurately reflect the growth of its use. The numbers of those doses given out by police and EMTs have fallen in the last three years but that’s because of greater access to the general public and possibly disruptions of service due to the pandemic.
Since the start of the pandemic the state has handed out 64,000 free doses to residents at more than 300 pharmacies and given 70,000 free doses to police, EMS, homeless shelters, libraries and inmate reentry organizations, Lovejoy said.
Along with naloxone, peer recovery specialists who try to steer overdose victims into treatment, typically after an overdose, have also kept the death toll in check. Five years ago, there were coaches in a few hospitals in the state. Now they operate in every county.
An expansion of Medicaid has also contributed, Thompson said.
Starting in 2018, New Jersey patients age 18 to 64 who are eligible for Medicaid were able to receive both short-term and long-term residential treatment for substance abuse. Prior to that, that age group was excluded.
“We used to see several weeks waiting time for a treatment bed. Now, it’s rare if it’s more than a day or two,” Thompson said.
Medications to fight addictions like Suboxone and Vivitrol are now much more available than they were five years ago.
One reason was Medicaid payment incentives to encourage primary care providers to offer medication, Lovejoy said.
And residential treatment facilities that received Medicaid reimbursements for addiction services are now required to offer Medication Assisted Treatment, she said.
It’s an important step since some people do not respond to the non-medicinal 12-step approach that many facilities use, Thompson said.
“We’ve over-relied as a field for decades on 12-step programs, which are very important and effective for some but not for everyone, “ she said.
More impressive is the steep drop in opioid prescriptions in New Jersey. The number of prescriptions has fallen from 5,640,864 in 2015 to 3,637,522 in 2020, a 38% decline.
The New Jersey Legislature passed a law in 2017 that limited initial opioid prescriptions to a five-day supply for most patients, which has been credited with the decrease.
Greenagel attributed some of that drop to Attorney General Gurbir Grewal’s strict stand against those illegally prescribing opioids.
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But education of medical staff on the dangers of opioids and the expanding Prescription Monitoring Program, a statewide database of prescription data, have also been key, he said.
Fentanyl strips and other options
Greenagel is still pushing for more training for doctors and other prescribers about the dangers of opioids and to make the Prescription Monitoring Program mandatory.
Thompson says “harm reduction” strategies like fentanyl testing strips for heroin users should be used to lower the death rate.
“An abstinence-only model is not the only option,” she said. “The only way we’re going to bring the death toll down is through harm reduction.”
More coordination of housing, employment and other services is also crucial, she said,
“There needs to be a single entity that makes sure all those services work together in a systematic way,” she said.
Major problems remain, Greenagel said.
Data on which treatment programs in New Jersey work and which do not is woefully absent, he said. There’s no uniform system to track how well patients do, particularly after leaving a facility, he said.
Insurance companies have some influence over creating a better model that could reward programs with proven success, he said.
“They (treatment providers) have an incentive to keep that data from the public,” he said. “Alcohol and drug treatment has gotten better in the last 20 years but it’s still very much in the dark ages.”
Ken Serrano has covered crime, breaking news, investigations and local issues in New Jersey for more than 20 years. Reach him at 732-643-4029 or email@example.com.
This article originally appeared on Asbury Park Press: Why NJ’s fatal drug overdoses remain flat as nation’s death rate spikes
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