Combating NJ’s Heroin Crisis

 

Jack Ciattarelli is an Assemblyman representing NJ’s 16h Legislative District. He’s currently the only announced Republican running to replace Chris Christie to become NJ’s next governor. PolitickerNJ invited all candidates including Assemblyman Ciattarelli to share their plan to curb NJ’s growing heroin/prescription drugs crisis.  His detailed plan follows below.

Combating NJ’s Heroin Crisis by Jack Ciattarelli

My plan for addressing our tragic heroin epidemic consists of four parts: access and availability; education; treatment, recovery and prevention.

Access and Availability

Since heroin use is 40 times more likely among those who develop an addiction to prescription opioid drugs, I have several proposals aimed at reducing the availability and access of these addictive medications:

  •         Build upon the Prescription Monitoring Program (PMP) with community clinicians (i.e., dentists, doctors and pharmacists) to cut down on ‘doctor shopping’ (i.e., the practice of seeing different doctors for purposes of getting multiple opioid prescriptions).  It’s also crucial we have access to surrounding states’ PMP databases.  (While we have some states, we do not have all.)
  •         The state needs to work more closely with medical societies, insurance companies and healthcare systems to shift the current pain management paradigm from prescribing opioid medications to alternative non-opioid medicines whenever clinically appropriate (e.g., using the new Centers for Disease Control and Prevention (CDC) guidelines restricting opioid prescribing and emphasis on alternatives to opioid pain management).  Closer monitoring of patients is also needed to ensure that addiction isn’t developing in those prescribed opioids.
  •         The state needs to promote an awareness program that strongly encourages adults to lock up prescription drugs at home, away from the reach of children.  Much how the state requires legally owned weapons to be safely locked away from children, opioid drugs, in particular, should be treated the same way.
  •         We need to promote the NJ Division of Consumer Affairs program “Project Medicine Drop” that places prescription drop off boxes for the disposal of unused and expired medications.
  •         We need to work with County Prosecutors to provide and better share resources, including intelligence that tracks and identifies drug trends.  We must also continue to expand drug monitoring initiative (DMI) efforts run by the Regional Operations and Intelligence Center (ROIC).
  •         We have to work closely with Drug Enforcement Administration (DEA) and High Intensity Drug Trafficking Areas (HIDTA) partners to provide resources to local police.  This requires ensuring proper staffing through the Task Force Officer program, training, advanced technology tools, drug dogs and trained officers in the field of DRE (i.e., DREs or drug recognition experts).

Education

In the community, I would support and seek to provide funding for high and middle school programs that provide education on the dangers of prescription drugs and heroin.  I’m also supportive of legislation mandating that community clinicians, at the time opioid drugs are prescribed and/or dispensed, counsel patients of the potential harm and risk of addiction.  I also support requiring continuing education for community clinicians on opiate addiction; how to identify an addict; and how to find local resources to help the patient/family.

Treatment, Recovery and Prevention

We must do everything we can to ensure access to treatment and high-quality care.  With regard to treatment, we need substance abuse assessments performed by trained professionals to identify the appropriate level of treatment.   Treatment involves discovering the underlying cause as well as overcoming the addiction.  The state should also ensure that there are county detox opioid centers have enough capacity to admit all those seeking treatment, including the uninsured. This currently is not the case.  Detox must also be, at the very least, extensive enough to truly decrease the likelihood of relapse.

We also need to increase reimbursement rates for outpatient substance abuse services.

Specific to recovery, the state must partner with support systems, recovery centers, workforce development centers and community clinics to ensure patients are properly treated and adhere to a recovery plan.   This can be facilitated by providing community development block grants in the community to facilities with expertise in addiction recovery.

That state should be implementing “warm handoffs,” where counselors are made available in emergency rooms to talk to patients. (When warm handoffs are not implemented, oftentimes a patient will be administered Narcan until they’re stabilized, only to get released and return home to continue their drug use.)  These counselors would refer patients to substance abuse treatments on the spot and follow up with them to ensure compliance.

I support expanding sober living centers and increasing access for recovering addicts to the documents they need for employment (in the case their driving licenses are revoked).  I support expungement of records for first offenders so long as their offense is not an “intent to distribute” and pending successful completion of a court-mandated rehabilitation program.  I’m also an advocate of drug courts.

The state needs to mandate insurance coverage of opioid partial agonists such as Suboxone, as this medication can be crucial to an addict’s detox process and less susceptible to abuse than other medications.

I would continue funding for syringe exchange programs as they not only prevent the spread of diseases but counselors at those programs can provide addicts with much-needed resources about treatment referrals.

Since heroin adulteration with fentanyls and the overdose rate has increased over the last year, I support any legislation codifying the Governor’s emergency order mandating that those caught with any of seven imitation versions of fentanyl are subject to the same criminal penalties applicable for the real drug.  This makes it a third-degree crime to manufacture, distribute, or possess any of the seven chemical compounds, punishable by a fine up to $25,000 and three to five years in prison. The use of fentanyl poses even greater risk to heroin users as many of them are unaware of the strength of the drugs they are encountering.  What is especially troublesome is that many do not know that even trace amounts of fentanyl can be deadly.  Drug users are usually unaware that their heroin is mixed with fentanyl so inadvertent overdoses are happening in greater numbers.

We also need to adopt regulations or legislation codifying the current Department of Health waiver allowing certified EMTs and paramedics to carry and administer Narcan.

A somewhat obscure issue that is crucial to combating the heroin epidemic is strengthening the rights of foster parents in our family court system.  The rates at which ‘heroin babies’ (i.e. neonatal abstinence syndrome [NAS] – babies born addicted to heroin from drug-use by their mothers during pregnancy) are born in NJ are skyrocketing.  For instance, in 2014, twice as many NAS babies were born as in 2008.  The statewide average for NAS births in 2014 was around 6 out of 1,000 babies.  Some parts of the state (i.e. Burlington, Camden, Gloucester, Salem and Sussex) averaged more than 1 addict baby out of every 100 births .  Even more troubling, more than 1 out of every 50 babies were NAS deliveries in Atlantic, Cape May and Cumberland counties. The statistics deeply concern me, especially considering these babies are 50% likely to develop addiction later on in life.  The chances for a long and fulfilling sober life are significantly increased if these babies are raised in drug-free homes.

I firmly believe in second chances and compassion in dealing with drug abuse, however, there comes a time when the best interests of the child must be put before the best interests of a parent struggling with addiction.  Our court system tends to see reunification as almost always in the best interest  of the child, but unfortunately, this is not always the case when they have a biological parent who simply cannot take care of themselves, let alone another life.  Chronic addicts who routinely discontinue rehab or make less than a good-faith attempt in complying with drug court orders should not be awarded custody, or even in some cases, visitation.

Currently, judges have discretion in permitting foster parents to be present at court hearings (family law hearings are private as opposed to civil or criminal law hearings).  In some cases where foster parents are not permitted to be present, addict parents can be less than honest with the court about their progress or the level of involvement with their children’s lives.  There are times when addict parents get custody or visitation prematurely, and these incidents could be prevented in part by mandating foster parents not only have the right to be present, but formally serve as parties to these court proceedings, which is currently not permitted.  Foster parents can serve as a resource for the judge to corroborate the biological parent’s claims.  We must find a balance between compassion and child protection if we are serious about combatting this epidemic. It is an injustice to the child, their foster family, their biological parent, and the state to allow an addict baby to be raised in a home that struggles with drug abuse.

Call to Action

There are many frightening statistics that show heroin use is spiking throughout the state. For instance, in 2014, there were more than twice as many heroin-related overdose deaths as there were in 2010.  Additionally, New Jersey’s per-capita rate of 8.3 heroin-related deaths per 100,000 people is more than triple the national rate and “now eclipses homicide, suicide, car accidents and AIDS as a cause of death.”  The state cannot afford any hesitation in addressing this tragic and challenging, but solvable epidemic.  With that, let all stakeholders and policymakers engage in an on-going and constructive dialogue and, in turn, earnestly endeavor to combat the epidemic.

Legislative District 16 includes Delaware Township, Borough of Flemington, Township of Readington, Township of Raritan, and Borough of Stockton in Hunterdon County; Princeton in Mercer County; Township of South Brunswick in Middlesex County; and Township of Branchburg, Hillsborough Township, Borough of Manville, Millstone Borough, Montgomery Township, Borough of Rocky Hill, and Borough of Somerville in Somerset County.