Gov. Chris Christie wants to tackle New Jersey’s opioid epidemic with an emergency measure that would place the state between doctors’ prescription pads and their patients.
Speaking at the State of the State address Tuesday evening, Mr. Christie called on New Jersey Attorney General Christopher Porrino to "use emergency rule-making and other regulatory reform to limit the supply of opioid-based pain medications," hoping that a reduction in initial prescription length from the current 30-day supply limit to just five could prevent some patients from becoming addicted to the pills.
New Jersey isn’t the first state to propose drastic steps in response to the nationwide opioid crisis. States such as Massachusetts, Connecticut, New York, and several others have passed similar laws, arguing that the action could reverse the upwards trend of opioid-related deaths, which jumped to a record of 33,000 in 2015, according to the Centers for Disease Control and Prevention (CDC). But pharmaceutical companies and doctors object. Some note that opioid prescriptions have declined 12 percent since 2012, as The New York Times reported. And they maintain that prescription lengths should be a conversation that takes place between doctors and patients without the government’s input, and worry that the interference could discourage doctors from prescribing opioids at all.
Research has yet to determine the long-term benefits of these new, shorter limits, but growing support for the measures among policymakers does show an emerging consensus about how opioid addiction begins.
“When you see a state legislature or governor or attorney general put forward this type of intervention, what it demonstrates is an understanding of what’s been fueling the opioid crisis,” Andrew Kolodny, the director of the Opioid Policy Research Collaborative at Brandeis University’s Heller School, tells The Christian Science Monitor in a phone interview. “Until very recently, which is why I think the epidemic has worsened … policymakers didn’t understand that over prescribing was fueling the problem.”
For years, opioids were viewed through two distinct lenses: heroin, a dangerous and illicit substance used by drug abusers, and painkillers, medications given to relieve the pain of those who were injured or underwent a surgical procedure, or suffered from chronic pain. Pharmaceutical companies spent the past two decades urging doctors to issue looser, lengthier prescriptions, using targeted marketing campaigns to dismiss fears that the pills could lead to serious addictions and normalizing drugs that were previously doled out sparingly in extreme cases.
But as the number of overdoses and fatalities associated with the drugs rose, more began to see that many of the people who lost their lives in the ongoing epidemic began using prescription drugs for a minor injury and quickly became addicted to the highly potent pills, a revelation that changed the face of addiction.
Mr. Porrino said Wednesday he planned to submit Christie’s recommended rules to state regulators by the end of the month. The rules could be put into place within 30 days under the emergency law statutes.
"This allows us to take action very quickly," Porrino told NJ.com.
Traditional legislative attempts to curtail the length of opioid prescriptions languished in the state, and a bill that would have placed a seven-day limit on the prescriptions died in committee last year, prompting Christie to seek alternative action. Christie says this issues is personal for him and made an impassioned speech about opioid addiction during a 2015 presidential campaign stop in N.H. that went viral on YouTube.
Additionally, on Tuesday, Christie called on Porrino to open "an investigation of the prescribing practices of our medical community and their interaction with the industry manufacturing these drugs," a move that mirrors investigations in New Hampshire and Chicago that resulted in lawsuits against opioid manufacturers.
The prescription limit won’t have an effect on those who are introduced to the drugs through heroin, and likely will play little role to keep those addicted to pain pills from overdosing, Dr. Kolodny says, noting that such measures aren’t a cure-all for the crisis. But the rules could limit the number of new patients that go down the road to addiction, as well as others in their homes who could get hold of the leftover pills.
“If you supply someone a 30-day supply when they only needed two pills, the rest are in the medicine chest where they’re a hazard,” he says. “We do need much more cautious prescribing.”
Experts are scrambling to find solutions to the epidemic, but some doctors maintain that blanketed limits undermine the authority and expertise of medical professionals.
“Arbitrary pill limits or dosage limits are not the way to go,” Patrice Harris, chairwoman of the American Medical Association’s committee on opioid abuse, told Pew Charitable Trusts last year. “They are one-size-fits-all, blunt approaches.”
But others argue that for minor procedures, including many things from a tooth extraction to regularly-performed surgeries, opioids are often over-prescribed, leaving patients with leftover pills in the bottom of bottles that go unused — until they’re picked up for a nonmedical or unauthorized purpose.
A five-day limit, while slightly stricter than the seven-day limits found in several other states, sounds reasonable, Jonathan Chen, an instructor at Stanford University School of Medicine who has researched opioid abuse, says. Including a provision that allowed patients who did not receive adequate dosages to return to their doctors for additional pills would be key. And while that may be an inconvenience for some patients and busy doctors, it could cut back on the excess of pills lying around.
He also said drug-monitoring databases, which allow doctors to see what prescriptions patients have received from other physicians in the state, can help doctors to catch abusers who frequent multiple clinics.
Caleb Alexander, co-director of the Center for Drug Safety and Effectiveness at Johns Hopkins University, told the Monitor in September that for many patients, opioid products are not terribly effective at treating chronic pain.
“There’s no conflict between improving the quality of care for those with pain and reducing opioid use. What’s been set up is a false dichotomy: one of the pushes of the pharm lobby is to argue that any effort to rein in runaway prescribing is going to cause suffering and deprive people of necessary pain treatments,” Dr. Alexander said.
Still, Dr. Chen says, there’s also a societal shift that needs to happen alongside the law, changing how patients and doctors view painkillers and prompting them to use and prescribe them less.
“It’s tricky,” he says. “It’s really a cultural change that has to happen to readjust those parameters.”
Others point to medical marijuana as a possible, less-addictive substitute. In states where the substance has been approved widely for medical use, the number of deaths related to opioid abuse fell by 25 percent.
Government intervention in the medical sphere remains largely unwelcome by doctors and patients, who often feel their levels of expertise and private, personal cases may not fit neatly into legislation. Still, others aren’t sure how to reverse years of overprescribing that have come to define modern pain medicine, and think legal action could be the most effective solution.
“I don’t know if I want [the government] to be the one doing it, but they’re kind of in the position to be doing it,” Chen says.