Understanding NJ’s 21 Heroin Treatment Bills

In March, the Governor’s Council on Alcoholism and Drug Abuse (GCADA) released its Task Force report on the Heroin epidemic. It charged the state to combat the problem by mandating the Prescription Drug Monitoring Program (PMP) along with over 20+ other suggestions. I have continually written about how the heroin epidemic is not new, that our lack in dealing with it in the past is rooted in racism and that Big Pharma should be held accountable. I have been publicly critical of Governor Christie and have urged him to approve legislation and fund a number of cost-effective programs. Now, a NJ leader has stepped up to the plate to truly address this issue. On September 17, Senator Joe Vitale led the way in proposing 21 bills to address the heroin and other opiate epidemic in NJ.

Stephen Sterling of the Star Ledger wrote an excellent summary of the bills the day they were released. With thanks to him, I am reprinting that summary here and have commented (in red) on each one below :

S-2366, sponsored by Senators Weinberg and Vitale, would ensure parents and patients are aware of the dangers of certain prescription drugs by requiring practitioners to inform them of their nature.
Good. This will explain the addictive nature of certain prescription drugs (not just opiates, but stimulants and benzodiazapines as well) and their numerous side effects. Consumers should be able to make better decisions when armed with proper information.

S-2367, sponsored by Senator Codey, would update New Jersey’s core curriculum on substance abuse to make sure that our students are receiving effective prevention education.

Fantastic. Students in middle school and high school need to get a comprehensive education on prescription drugs. The marijuana curriculum needs to be overhauled as well in the face of growing social acceptance. These programs should begin at age 10. If the state can’t pass this, then local school boards should address it.

S-2368, sponsored by Senator Rice, would increase state funding for substance abuse prevention efforts by $5 million.

This money is appreciated. That said, $5 million is a pittance in terms of a state budget.

S-1998/A-3129, sponsored by Senators Weinberg and Vitale/ Assemblymen Conaway and Lagana, Assemblywoman Angelini, Assemblyman Benson and Assemblywoman Sumter, would require all physicians to register for the state Prescription Monitoring Program, which helps identify individuals who are doctor shopping for opiates and would help identify rogue prescribers operating “pill mills.”

Exceptional. Like vaccines and the concept of herd immunity, the PMP is only effective if it is mandated. Over a dozen other states have some form of a mandated PMP. Our Task Force, under the guidance of the Attorney General’s office, suggested that masters-level and above mental health and addiction treatment providers have access to the PMP as well. This is one of the most important bills. It also has a low likelihood of being approved by the Governor. (My only concern with this version is that there may be language in it that doesn’t require all prescribers to access the PMP each time they are giving someone a prescription – to work, there has to be a mandate).

S-2029, sponsored by Senators Turner and Vitale, would enhance data collection and resource targeting by government agencies by allowing, with parental permission, for students to participate in voluntary surveys such as anonymous substance abuse surveys.


S-2369/A-2859, sponsored by Senators Whelan and Kean/ Assemblymen Eustace and Benson and Assemblywoman Vainieri Huttle, would increase the number of places individuals can drop off unused prescription drugs by expanding “Project Medicine Drop” locations to every State Police barrack, every county sheriff’s office and in county and municipal police departments that chose to participate.

Good. This should be effective when combined with former Attorney General Eric Holder’s recent announcement that hospitals and pharmacies should take back drugs as well.

S-2370/A-709, sponsored by Senators Whelan and Kyrillos/ Assemblywoman Angelini, Assemblyman Benson and Assemblywoman Sumter, would increase public awareness of safe disposal of prescription drugs by requiring pharmacists and prescribers to notify patients of proper and safe disposal options.

Good. Easy to do. Not controversial.

S-2371, sponsored by Senator Barnes, would improve our understanding of overdose trends by requiring the state poison control to establish a clearinghouse of drug overdose information.

Good. Easy to do. Inexpensive. Not controversial.

S-2372/ A-1436, sponsored by Senators Madden and Oroho/ Assemblywomen Caride and Mosquera, would create a Statewide Opioid Law Enforcement Task Force to identify, investigate and prosecute illegal sources and distribution of opiate drugs and to provide training for law enforcement, physicians, pharmacists and other health care professionals to detect and divert drug abuses.

The State Attorney General’s Office and State Office of Criminal Investigations (SCI) have already been doing this. This is a fine idea as long as it isn’t redundant and/or doesn’t lead to fights between different parts of the government.

S-2373, sponsored by Senators Vitale and Addiego, would provide consumers with a better understanding of treatment options by requiring the Department of Mental Health and Addiction Services to annually compare and rank substance abuse providers.

It’s a good concept. I’m not sure how DMHAS would identify what is good or bad or how they would report it. We probably need an independent watchdog to do this.

S-2374, sponsored by Senators Vitale and Singer, would increase the rate that Medicaid providers are reimbursed for evidence-based behavioral health care to the going market-rate, which in turn will increase the number of practitioners willing to take Medicaid patients.

I have no idea where they will get the money for this.

S-2375, sponsored by Senator Vitale, would remove red tape that keeps ambulatory care facilities from providing behavioral health care services without multiple licenses.

I’m wary of this one. Those facilities need to be required to have a LCADC that can provide the necessary treatment; otherwise there will be a degradation of care.

S-324/A-2266, sponsored by Senator Gordon/ Assemblywoman Vainieri Huttle and Assemblyman Lagana, would create a Behavioral Health Insurance Claim Advocacy Program to provide assistance and advocacy in navigating insurance bureaucracy to those with behavioral health care conditions.

When the state government fights with insurance companies, the insurance companies usually win. I’m skeptical that a new bureaucracy could effectively do this.

S-2180/A-3450, sponsored by Senator Gordon/ Assemblywomen Vainieri Huttle and Pinkin, would ensure that those with behavioral health care conditions are eligible through their insurance to receive services prescribed by licensed physicians, physician assistances, psychologists, clinical social workers and certified advance practice nurses by prohibiting insurance companies to deny coverage through their own utilization management review.

This is the Holy Grail. The insurance companies need to be brought to heel. They have continually either provided a lower level of care than is required, shortened the length of suggested treatment or denied coverage all together. When insurance companies have to pay claims, some of them internally call it a medical loss. They are a business, and they make money by paying as little as possible for treatment. The Affordable Care Act and the Parity Laws have attempted to address this, but the insurance companies are still not following through in many cases. This will have to be fought out through litigation, and will probably end up in the Supreme Court.

S-2376, sponsored by Senators Vitale and Gordon, would help doctors coordinate with specialists through telecommunications rather than expensive face-to-face patient visits by creating a grant in the Department of Health to expand remote medical consolations.

I don’t know enough about this to offer up an opinion.

S-2377, sponsored by Senators Barnes and Vitale, would require New Jersey’s colleges and universities to provide substance abuse recovery housing options.

This is a nod to the amazing work that Rutgers has done with its ADAP and Recovery Housing programs. By requiring recovery housing, schools are also required to have at least one full-time licensed clinical alcohol and drug counselor (LCADC). Schools should have at least one for every 5,000 students. Community Colleges should also employ at least one LCADC.

S-2047, sponsored by Senators Kyrillos and Vitale, would ensure that the Department of Human Services have regulatory oversight of substance abuse treatment facilities;

Will they monitor halfway houses for people coming out of the criminal justice system too? Probably not. Governor Christie’s buddies make too much money on that. Recovery Houses are unregulated and need to be overseen by the state as well.

S-2378, sponsored by Senators Vitale and Singer, would extend the
Overdose Prevention Act to provide immunity to law enforcement professionals for delivery of an overdose antidote and would require all syringe access programs to carry and dispense the antidote to needle exchange participants.

Great idea. Easy.

S-2379, sponsored by Senators Vitale and Lesniak, would create a three-year pilot program to enroll pre-trial incarcerated individuals in Medicaid, providing more individuals with coverage and eligibility to enroll in court supervised substance abuse treatment programs.

This only works if they greatly increase the amount of money that Medicaid pays for treatment services.

S-2380, sponsored by Senators Vitale and Lesniak, would ensure that inmates are receiving treatment approved by the agency with the most appropriate expertise and experience by requiring joint regulatory authority over prison-based mental health and substance abuse programs between the Department of Corrections and the Division of Mental Health and Addiction Services.

Great idea. Treatment (and education) will reduce recidivism and save the state a large amount of money. Governor McGreevey has been one of the champions of this idea for several years.

S-2381, sponsored by Senators Vitale and Lesniak, would permit successful completion of certain drug treatment programs operating in state prisons and prohibition drug court programs for those who are using certain medication assisted treatment such as methadone.

Another good concept. I expect the Drug Courts will fight this. Using methadone to describe this is an error, for that drug has negative connotations. Buprenorphine and Vivitrol are more effective and less controversial. But the theme of the idea is a good one. 



Xanax and Valium Linked to Alzheimers Disease

In the 60’s, we started hearing reports that tobacco use caused cancer. Big Tobacco denied this. Reports are now coming in that links benzodiazepines (Xanax, Valium, Mick Jagger’s “Mothers Little Helpers”) to Alzheimer’s Disease. Nothing is conclusive yet, but the correlation is alarming.

The reaction to it is startling to. The power of denial continually amazes me.

Here is a link in The New York Times to the study links anxiety drugs to alzheimers disease.

Governor Christie Must Walk His Big Talk

When Governor Christie took office in 2010, it was the first time that NJ had a Republican Governor since Governor Whitman resigned in 2001 in order to head up the EPA under President Bush. Christie had been the US Attorney for NJ, so I was not expecting much out of him in the areas that I have the most expertise in: education, criminal justice, and mental health and addiction treatment.

Early on, there were promising signs. In 2011, Eric Arauz and I were named to the Governor’s Council on Drug Abuse and Alcoholism. We were told that Christie had once served on the Board of Directors for Daytop Mendham, an adolescent in-patient treatment facility in Morris County. Apparently a young man who had graduated from Daytop had moved Christie with his story of addiction to crack and how he attended college and then law school in recovery. In 2012, the GCADA put together a Task Force to investigate the heroin and opiate epidemic (after a lot of political nonsense and delay, our report was released in March of 2014).

In July, 2012, Governor Christie signed a bill into law that expanded the NJ Drug Courts. It costs $55,000 to incarcerate someone in NJ but only $12,000 to put them on drug court and give them treatment. Treatment is better than punishment, and even if you don’t agree with that statement, it comes in at about 22% the cost. Even though I disagreed with the Governor on a number of issues, I was thrilled that he had taken action on addiction treatment. It was helpful that he was a Republican and a former US Attorney; if a Democrat had pushed the Drug Court expansion she would have been viewed as a bleeding heart liberal and soft on crime. Christie could do it and not have to deal with much political or public backlash.

After a few months, I heard rumblings that even though Christie had signed the bill, he hadn’t provided actual funding for it. I was told that it was an old political trick: publicly supporting something and then not funding it. I was getting an interesting education in Trenton. I was discouraged, but I hoped that the Governor hadn’t just funded it yet, and that once he addressed the state’s budgetary issues he would pour money into prevention, treatment and recovery support services.

The first sign of real trouble appeared in the fall of 2012, when Christie vetoed the Good Samaritan Bill, which would have helped prevent a number of overdose deaths. He vetoed it despite the impassioned pleas of hundreds of parents of kids who had died from overdosing (in 70% of overdose deaths, the evidence at the scene shows that people were not alone when they died, but no one called for fear of getting into trouble). Policy makers and those parents were distraught and sought to create a groundswell at the local level. Websites were made, petitions signed and municipalities passed proclamations in support of the Good Samaritan Bill. Christie refused to budge. Then, Jon Bon Jovi’s daughter overdosed at Hamilton College in upstate New York. Because New York had already passed their Good Samaritan Law, Ms. Bon Jovi did not die. Advocates called on Jon Bon Jovi, who agreed to reach out to the Governor. On May 2, 2013, Governor Christie announced that he had “changed my mind” and signed the Overdose Prevention Act.

My father is an Eisenhower Republican and my mother has usually voted for Republicans. I tend to like moderate Republicans (Governor Tom Kean, President Nixon, President Ford, John McCain circa 2000), but they are a highly endangered species. I hadn’t voted for a major Republican candidate in well over a decade, but decided to cast my vote for Governor Christie in the fall of 2013. He talked a good talk about addiction. I was hoping that he would walk it.

This spring, he spoke before a group of doctors and urged them to use the state’s PMP. But he wouldn’t require doctors to use it, despite the fact that our Task Force report suggested it (at the behest of his Attorney General’s office) and that nine other states had mandatory PMP’s. A few days later, Christie met with a number of ex-offenders whose lives had been improved by going to college. Studies show that providing a college education reduces recidivism by more than 50% and therefore, makes a tremendous amount of economic sense. Christie said that it was a great idea but that he would not publicly fund it (I don’t hold this against him…it is extremely difficult for a politician to back this with public funds). The Governor had developed a new playbook that had him make appearances, talk about how he cared about the issue, that he was rooting for people and then he would leave without any promise of making any real change or providing funding.

Despite this, I was (for the most part) pleased with his stance on marijuana. I am very much opposed to outright legalization and I’m appalled at how Democratic officials are supporting legalization without a better understanding of the issues.

Last week, Senator Joe Vitale of Woodbridge introduced 21 new bills to tackle the heroin and opiate epidemic. Some highlights:

(1) mandate the PMP

(2) improve middle and high school curriculums to address prescription drug abuse

(3) insurance reform

(4) create treatment programs inside of NJ prisons

(5) improve oversight of treatment programs to ensure better service

(6) require all NJ colleges to have Recovery Housing programs

These are good ideas. Passing and funding them can go a long way to addressing the Heroin epidemic in NJ, as well as a improving substance abuse prevention and treatment. Governor Christie has deservedly earned a lot of praise for his stance on these issues. He talks a good talk and says all the right things. He connects with people and claims to care. But when it comes time to pass laws and fund programs, he comes up lacking. Over and over.

This is his moment. I hope he chooses wisely. Governor Christie: please walk your big talk.




It’s Time To Shut Down Fraternities and Sororities

On Sunday morning at 3:19 am, Caitlyn Kovacs, a 19-year-old sophomore at Rutgers died after going to a “small gathering” at the Delta Kappa Epsilon (DKE) Fraternity House on College Avenue in New Brunswick. Nothing has been confirmed yet, but the speculation is that Ms. Kovacs died of alcohol poisoning. Over the next few weeks, we will see a renewed discussion about the dangers of college drinking and what can be done to address a problem that has gone on for centuries.

In 1997, The Harvard Crimson published a high-profile history of on-campus alcohol deaths. One of those incidents involved a Rutgers student in 1988:

James Callahan, an 18-year-old Rutgers University student, dies after consuming 24 ounces of hard liquor in less than an hour as part of a pledging ritual at the Lambda Chi Alpha fraternity, according to an April 26 article in The Record. A separate article reported on Aug. 28 that this incident prompted a five-year shutdown of his fraternity.

Ten years later, during my sophomore year at Rutgers, another Fraternity student died in an alcohol-fueled incident:

A Rutgers University junior who suffered serious head injuries when he fell down a flight of stairs at his Fraternity house after several hours of drinking at an off-campus bar was removed from life support early yesterday. Jason Greco, 20, a Riverton native and former captain of the Palmyra High School football team, was declared clinically dead Sunday morning at Robert Wood Johnson University Hospital in New Brunswick.

The article, which I’ve linked to on the young man’s name, has a number of familiar quotes and brings up some disturbing points:

As family and friends mourned Greco’s death yesterday, the accident brought attention once again to how tightly alcohol is woven into the fabric of college life. Despite alcohol prevention and education programs offered at Rutgers and other universities in the region, the level at which college students consume beer and liquor continues to concern administrators.

“We have long recognized that underage drinking and dangerous drinking has been an issue that colleges face,” said JoAnn M. Arnholt, dean of fraternity and sorority affairs at Rutgers. “I hope people learn a lesson from this, that no one is immune from an accident like this.”

Rutgers is requiring all fraternity houses to be substance-free by 2000. Rutgers administrators said Greco’s death had forced the school to continue to scrutinize whether its policies are allowing students to fall through the cracks, and whether its policies can prevent tragedies such as the death of Greco.

Three students died in alcohol and fraternity related deaths. Each time the student was mourned by friends and family and the college culture of drinking was cited as a difficult problem to address. College administrators expressed concern. Clearly, Rutgers failed in making fraternity houses substance-free by 2000. These stories read like Groundhog Day on deja vu steroids.

After Mr. Greco died at Rutgers in 1998, Rutgers told the Fraternities that they had to remove the bars from the Frat-House basements. The New York Times reported that:

One fraternity, Alpha Delta Epsilon, has challenged the university’s order, contending that it should be exempt. Its alumni president, Matthew R. Schutz, a lawyer from Flemington, N.J., believes the fraternity’s bar should be retained because the fraternity’s alumni have deemed it a memorial to members who have entered government service, or the fraternity should be compensated for its loss.

The Fraternities didn’t get it then, and they don’t get it 25 years later. Mr. Schultz’s claim was as farcical as it was short-sighted and irresponsible.

In 1989, The New York Times ran a story about how Rutgers had created a number of positive programs to address the drinking culture, including (1) the presence of the Center of Alcohol Studies, one of the premier research institutions in the world; (2) the Rutgers Recovery House, the first on-campus recovery house program in the world; and (3) outpatient counseling services available at the on-campus counseling center.

Despite the presence of these avant-garde programs, alcohol and drug problems keep erupting out of Fraternity and Sorority Houses at Rutgers. This also holds true around the country. Members of Greek Life argue that they request annual training on alcohol and drug problems, but former Rutgers Vice-President W. David Burns had this to say about that:

Mr. Burns added that education and awareness programs are sometimes requested disingenuously by student groups to make it appear that they are concerned with curbing their drinking habits.

Nationwide, the yearly statistics related to college drinking are staggering and harrowing:

– Approximately 1,800 student deaths
– 600,000 unintentional injuries
– 700,000 assaults (100,000 sexual assaults)
– Lower grade point average
– 31% met criteria for alcohol abuse or dependence
– $53 billion social cost for underage drinking
– 100,000 students report having been too intoxicated to know they consented to having sex

College drinking and curbing Fraternity life has been in the news this week, even before Ms. Kovacs died at the Rutgers Fraternity yesterday. On September 16, NPR ran a story about how Frostburg State University is trying to combat underage and binge drinking on campus.  FSU has extra police working on the weekends and they have paid for off-campus bar workers to learn how to better spot fake ID’s. They have also increased the number of Friday morning classes and have doubled the number of alcohol-free events offered on campus during traditional drinking hours.

Today, Wesleyan University announced that it was putting an end to all-male Fraternities. Disappointingly, they are only forcing them to admit women rather than completely shutting them down. This move was made of because of the high number of alcohol-related problem-incidents and the “rape parties” that the Fraternities have held on campus over the last few years.

Schools should offer more alcohol-free events and continue to work on changing the culture with PSA’s and social norms campaigns, like RU Sure. But there is a bigger step to be taken. Wesleyan is on to something, but they need to take the training wheels off of their plan.

Fraternities and Sororities, which make up Greek Life, contribute to a huge number of significant problems on campus without bringing much to the table. Before a Greek Life supporter cites the charity work that they do, I’d like to point out that Donald Sterling donated a lot of money to the NAACP and that Philip Morris donated money to teenage anti-smoking ads. Ray Rice will probably end up taking part in Domestic Violence Awareness messages. Whatever good that Greek Life adds to the school is disproportionately offset by the tremendous negativity, irresponsibility and flat out harm they inflict upon the rest of the student body.

The Greek Life hit list (please click on each link):

(1) They are bastions of sexual assault. Google search college fraternities and sexual assaults and see what comes up. Sexual predators in those Frats have weaponized alcohol and drugs.

(2) They hold racist parties. Partygoers are encouraged to dress up as Asians at Duke University, Mexicans at Randolph Macon, and black thugs at Arizona State on Martin Luther King Jr.’s birthday.

(3) They have fought integration. It was only in the last year that the University of Alamba Greek chapters finally integrated.

(4) They haze people. Again, another horrible story out of my Alma Mater from 2010: “At Rutgers, six members of Sigma Gamma Rho were arrested in January and charged with aggravated hazing, a felony, after a pledge reported that she had been struck 200 times over seven days before she finally went to the hospital, covered with welts and bloody bruises.”

(5) They are often involved in cheating scandals.

(6) Women are sexually objectified. Even more so than is typical in American culture.

(7) Despite sexual objectifying women, they “slut shame” non-Greek women and hold them to a different standard.

It’s time to end the horror that is perpetrated by the Fraternities and Sororities on the rest of the student body. You want progress. Shut them down.


Do Employers Have The Right to Screen Employees For Drugs?

Yes. They do. But…with recent legislation in Washington and Colorado, that might change.

I think one would be hard pressed to find a business owner or manger who doesn’t have concerns about the performance (not to mention the attendance or quickness) of employees on drugs.

Here is a fascinating article about a man in Colorado who had a legal, medical marijuana prescription but was fired in 2010 for having a positive urine screen for marijuana. He explained his situation to his employer, but his employer maintained that they have the right to enforce a drug free work zone. Additionally, his employer stated that if they don’t maintain a drug free work zone, they are in violation of federal law. The case will go to the Colorado Supreme Court on September 30th. It’ll be interesting to see what happens.

You can read more about it in the New York Times: Legal Use of Marijuana Clashes With Workplace Testing.

Clearly, I think businesses should have the right to screen for drugs and deny employment to someone who tests positive and does not want to go to treatment for it.