NEW JERSEY – Attorney General Gurbir Grewal, the New Jersey Coordinator for Addiction Responses and Enforcement Strategies (“NJ CARES”), and the Division of Consumer Affairs Thursday announced that New Jersey physicians, dentists, and other healthcare practitioners who prescribe opioids for the management of chronic pain must also prescribe the opioid antidote naloxone to certain at-risk patients during the COVID-19 crisis.
Under an Administrative Order issued today, prescribers must co-prescribe naloxone to any patient continuously receiving opioids for chronic pain management if the patient has one or more prescriptions totaling 90 morphine milligram equivalents (MME) or more per day, or is concurrently taking an opioid and a benzodiazepine. These patients face heightened risk of a fatal overdose.
The Administrative Order aligns with a rule proposed by the State Board of Medical Examiners on April 6, 2020. That proposed rule, published in the New Jersey Register on April 6, 2020, is open for public comment until June 5, 2020.
The Administrative Order also applies to prescribers licensed by the State Boards of Dentistry, Nursing and Optometrists. These Boards have approved proposed amendments to their rules that are substantively identical to the co-prescribing rule proposed by the State Board of Medical Examiners but have not yet published the proposals in the New Jersey Register.
The Administrative Order responds to concerns that individuals with respiratory diseases may be more susceptible to opioid overdoses, that increased isolation and anxiety brought on by the COVID-19 crisis may increase rates of drug abuse, and that the pandemic may disrupt addiction treatment and support systems. In addition, by promoting the availability of naloxone among the general public, the Administrative Order may reduce how frequently law enforcement and Emergency Medical Services (“EMS”) first responders are called upon to respond to overdoses and use personal protective equipment to do so.
“The COVID-19 pandemic presents new challenges for individuals struggling with substance abuse disorder, and we are committed to protecting both them and the first responders who are typically called to treat drug overdoses,” Grewal said. “The action we are announcing today will enable us to save more lives, and to do so with fewer deployments of law enforcement and EMS first responders, so that we can preserve personal protective equipment that remains in high demand.”
“Co-prescribing naloxone gives chronic pain patients and their families ready access to a lifesaving antidote to reverse an opioid overdose,” said Sharon M. Joyce, Director of NJ CARES. “This is critically important at a time when the very necessary social distancing and stay-at-home orders are in effect to stop the spread of COVID-19.”
“Co-prescribing naloxone to at-risk patients is widely recognized as an effective way to reduce overdose deaths, and New Jersey was already moving in that direction,” said Paul R. Rodríguez, Acting Director of the Division of Consumer Affairs. “The administrative order announced today allows us to expeditiously expand the availability of this live-saving drug at a time when we need it most. This measure will help reduce overdose deaths and increase the ability of our law enforcement and first responders to respond to other emergencies during this critical time.”
The Administrative Order on co-prescribing may be in effect for the duration of the public health emergency or the state of emergency declared by Governor Murphy, whichever is longer.
Statewide, there were 253 suspected drug overdose deaths in March 2020, up from 215 in March 2019, and there were 241 suspected drug overdose deaths in April 2020, compared with 209 in April 2019.
Naloxone administrations are also up. In March 2020, there were 1,237 naloxone administrations by law enforcement and EMS statewide, up from 1,139 in 2019. In April 2020, there were 1,197 naloxone administrations, up from 1,054 recorded in April 2019.
Underscoring the need for at-home access to opioid antidotes, information gathered from naloxone administrations by EMS from January 1, 2020 through March 31, 2020 indicates hesitancy on the part of individuals with substance use disorder to be treated at hospitals during the public health emergency. For example, in March 2020, 20% of individuals administered naloxone by EMS refused transport to the hospital, while in February 2020, only 13% refused to go to the hospital.
Finally, there is significant concern that overdose numbers will increase due to all of the stressors associated with COVID-19, such as unemployment, grief, and decreased access to social services.
Individuals seeking mental health and/or addiction services can find a list of available resources online at NJ CARES.