New Jersey Department of Human Services Response to the Opioid Crisis

CE Credits Maria P. Kirchner, PhD

Robert Eilers, MD, MPH

According to a National Safety Council report, Americans are now more likely to die from accidental opioid overdoses than car crashes (NSC, 2019). In 2017, which is the last year in which overdose death data is confirmed, 70,237 drug overdose deaths occurred in the US. For every drug overdose that results in death, there are many more nonfatal overdoses, each one with its own emotional and economic toll, disrupting lives and communities. This fast-moving epidemic does not distinguish among age, sex, race, or state or county lines.

Abstract:

As in the rest of the United States, the opioid crisis has become a major public health problem throughout New Jersey. Opioid-related deaths from the use of prescription opioids, heroin, and illicit fentanyl and fentanyl analogs have increased at unprecedented rates. Through the perspective of one of the state agencies tasked with addressing the problem, the New Jersey Department of Human Services, we describe how the state has responded to this challenge. Supported by targeted State investments from New Jersey Governor Philip Murphy’s opioid initiative and federal funding, and with changes in law and policy, the state developed an array of prevention, treatment, and recovery support services for those with opioid use disorder (OUD). Key objectives of these initiatives included expanding access to medication assisted treatment (MAT), reducing unmet treatment need, preventing deaths from opioid overdoses, and supporting individuals in recovery. The critical role of psychology is highlighted, as these clinicians provide evidence-based counseling and behavioral therapies for OUD that are an important part of MAT and complement recovery support services.

Introduction

The United States is facing increases in opioid use disorders (OUDs) and overdose deaths that have reached unprecedented levels (CDC; WISQUARS).

Although the focus of this article gives an overview of the actions of the Department of Human Services (DHS) that is home to both the Division of Mental Health and Addiction Services (DMHAS) and Division of Medical Assistance and Health Services (DMAHS; also known as Medicaid), DHS has worked in close partnership with other state agencies, especially the Department of Health (DOH), Department of Children and Families (DCF), Department of Corrections (DOC), and the Office of the Attorney General (OAG). These agencies have been tasked by Governor Philip Murphy to take a whole-of-government approach in combatting the opioid crisis in NJ.

The initiatives described below are not exhaustive, nor do they minimize the efforts of numerous public and private entities in NJ. This crisis has, and will continue to, demand a comprehensive and collaborative array of initiatives from both public and private entities.

The strategies that the state used to address the opioid crisis include changes in laws, policies, licensing, insurance coverage, program developments, direct funding of services, data collection, and professional and public education. Psychologists significantly contribute to effective addiction treatments by utilizing evidence-based modalities and will continue to lend their expertise and provide direct services in the future.

Overview of the Opioid Crisis

Overdose deaths in the US have been increasing for three decades, with annual totals of drug-related deaths doubling over the last decade (CDC, 2019). According to Centers for Disease Control and Prevention, National Center for Health Statistics, Americans’ life expectancy dropped for the very first time since World War I for three consecutive years, due, in part, to the country’s surge in drug overdose deaths and climbing suicide rates. The overprescribing and misuse of synthetic opioid pain medications have been considered the primary drivers for the dramatic increase in opioid deaths in the last few years. Although synthetic opioids are manufactured by pharmaceutical companies, they are also manufactured illegally in clandestine labs and distributed through the illicit drug market; the prime example is fentanyl that is a synthetic opioid considered 50-100 times more potent than morphine and has surpassed heroin as the opioid most often responsible for overdose deaths in the US (CDC, 2019). Use of heroin has also been increasing in recent years as prescription drugs have become more difficult to obtain and heroin is less expensive and more widely available. Some of the greatest upsurges in heroin use have occurred in demographic groups with historically low rates of heroin use: women, the privately insured, and people with higher incomes (CDC, 2019).

Drug-related deaths in NJ have been increasing every year for more than the past decade. While the total number of overdose deaths was 843 in 2010 and 1,587 in 2015, this number jumped to 2,529 in 2016 and 2,685 in 2017, approaching eight overdose deaths per day on average. The number of deaths in 2017 represents an increase of approximately 24% over the 2016 death toll (approximately 6 per day). The 2018 data on overdose deaths (unconfirmed) is 3,118 (NJCARES). Heroin is the drug most often implicated in drug-related deaths in NJ, probably because highly pure heroin can be obtained relatively cheaply. Nevertheless, fentanyl deaths in NJ have also shown a major rise. While 417 deaths were classified as fentanyl-related in 2015, this number increased in only two years to 1,429. None of the increases in other substances, heroin, morphine, cocaine, oxycodone or methadone reached such a disproportionate high. The data confirm that opioid use has become a pervasive problem throughout NJ and is not limited by race, ethnicity, or socio-economic group.

New Jersey’s Initial Response to the Opioid Crisis

At a press conference in Camden, in January 2019, Governor Philip Murphy publicly pledged that he was committed to increasing access to evidence-based prevention and treatment programs; supporting recovery; building sound data systems and strong system-wide infrastructure; and enforcing laws to stop the supply of illicit drugs and support diversion initiatives. The governor’s commitment was evidenced by his proposing and securing $100 million in new State funding to combat the opioid epidemic in 2018 and continuing this funding in 2019.

The governor also called for a datadriven and person-centered response to the opioid crisis, with a whole-of-government response focused on increasing access to what works, including naloxone (otherwise known as Narcan) to prevent opioid overdose deaths and medicationassisted treatment (MAT) for individuals with substance use disorders.

In June of 2019, Governor Murphy announced free distribution of naloxone, the opioid overdose reversal drug, at participating pharmacies throughout NJ in what is believed to be the largest single day distribution of naloxone in the country, a total of 16,000 naloxone kits, or 32,000 doses, were distributed for free, with no prescription or identification required, by participating pharmacies in the state.

Also, in 2019, the governor announced that Medicaid lifted prior authorization requirements for medicationassisted treatment, new reimbursement incentives for providers to offer MAT, new investments in training healthcare providers on opioid use disorder treatment, and new clinical supports to help healthcare providers manage patients with substance use disorder.

The governor’s initiative is also investing in recovery supports through employment training and supportive housing for those impacted by opioid use.

Preventing Opioid Overdose and DrugRelated Deaths

The State’s earliest actions tried to stem the rising numbers of opioid overdose deaths. Police, Emergency Medical Technicians, and other first responders around the state started to carry and, in many cases, utilize naloxone to reverse opioid overdoses and prevent deaths. Nevertheless, few individuals at the side of an overdose victim had carried naloxone or knew how to respond to an overdose emergency. In May 2013, NJ enacted the “Opioid Antidote and Overdose Prevention Act,” allowing physicians to prescribe naloxone to anyone in a position to assist others during an overdose. The Act also provides both civil and criminal immunity and from any professional discipline for health care professionals and other persons involved in prescribing, dispensing, or administering naloxone. More significantly, immunity from arrest, prosecution, or conviction for drug offenses is also in effect when any person, in good faith, seeks medical assistance for the victim of an overdose. Finally, the Act authorized the DHS to develop a bystander training program that includes the use of naloxone in overdose emergencies.

Subsequently, DMHAS, in collaboration with the Governor’s Council on Alcoholism and Drug Abuse (GCADA), awarded funding to three organizations to establish regional Opioid Overdose Prevention Programs (OOPPs) that provide at-risk individuals and others with naloxone rescue kits and educate and train them on how to prevent, recognize, and respond to an opioid overdose. In addition to targeting individuals with an Opioid Use Disorder (OUD), their families, friends, and associates, the programs provided training and kits to medical service teams, HIV programs and other community-based public health organizations, fire departments, homeless shelters, community health clinics, personnel at statewide school districts, medical and clinical staff at jails, and residential drug treatment programs.

Another early State initiative, the Opioid Overdose Recovery Program (OORP), sent trained peers to emergency rooms to engage individuals who had just been reversed with naloxone with the goal of encouraging treatment. The peers (primarily individuals in recovery) and patient navigators (a newly created position, described below), provide nonclinical assistance, recovery support, and appropriate referrals for assessment and substance use disorder (SUD) treatment while also maintaining follow-up with these individuals. When an individual has been reversed from an overdose, recovery specialists are notified and deployed to the emergency room within one hour. OORP workers follow-up with these individuals for at least eight weeks. In most instances, services are provided 24 hours a day by OORP workers. Recovery specialists are accessible and on-call in the specific locations where services are provided. The OORP program is in 54 of 78 Emergency Departments (EDs) and in all 21 counties. Internal reports from these counties suggest the proportion of individuals, who are linked to services following an overdose, have increased significantly after OORP was launched.

In September 2016, DMHAS was awarded a grant from the Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Substance Abuse Prevention, to implement the Opioid Overdose Prevention Network (OOPN) initiative. This data-driven public health collaboration with universities and other state agencies targeted highneed communities that are identified as “Prevention Pathways.” Prevention Pathways uses evidence-informed, substance abuse mitigation strategies that utilize a comprehensive approach designed to prevent, reduce, and eliminate drug abuse and misuse in NJ. A critical partner is the NJ State Police Regional Operations & Intelligence Center (ROIC) is a state-ofthe-art facility that collects data on crime, illicit drug retrievals, and overdoses. It combines data from several sources, such as state, public, and behavioral health and the drug monitoring initiatives, on hospital encounters, naloxone deployments, and drug-involved arrests and deaths, and then aggregates, analyzes, and maps the data to target treatment and prevention services.

Restricting the Prescribing of Opioids

Another early action was the February 2017 passage of a new law that limited the prescribing of opioids to prevent misuse and development of opioid dependency. The law was hailed by some as the toughest opioid prescription law in the nation.

In addition to limiting the initial prescription of opioids in the treatment of acute pain to a five-day supply, the law requires that prescribers consider non-opioid alternatives for pain, warn patients about the potential of addiction, and make the goal to stop opioids short-term. Prescribers need to use the lowest effective opioid dose and to stop subsequently opioids for acute pain. If patients require chronic opioid use, the law mandates that prescribers create a pain-management treatment plan and a documentation of a discussion of risks with patients.

Another requirement was signing up for the state’s Prescription Monitoring Program (PMP) that gave prescribers critical information about their patients’ misuse of prescribed medications. The effects of the law are difficult to evaluate, but the widespread publication of the perils of opioids and the potential penalties that physicians faced for inappropriate prescribing, along with the increased training of physicians, seemed to have an effect; the state began to see a gradual trend toward lower rates of opioid prescriptions in subsequent years.

In September 2016, NJAssessRx initiative was implemented, allowing interagency sharing of the state’s PDMP data and the capability of using data analytics to identify prescribers, prescriber groups, and patients at high risk for inappropriate prescribing and nonmedical use of opioid drugs. Informed by the data, communities and populations were strategically targeted for services or education. The focus was on youth (ages 12-17) and adults (18 years of age and older), who are being prescribed opioid pain medications, controlled drugs, or Human Growth Hormone, and are at risk for their nonmedical use.

Funding for New NJ DHS Opioid Initiatives

State and federal governments recognized that a major increase in funding was necessary to address what was broadly recognized as a national crisis. The Comprehensive Addiction and Recovery Act, known as CARA, signed by President Obama on July 22, 2016, became the first major federal addiction initiative that had been passed in four decades and provided $181 million mostly for harm reduction and prevention services. The passage of the 21st Century Cures Act followed, and it provided $1 billion for treatment to address the opioid crisis. In May 2017, the Cures Act provided NJ with almost $13 million annually for two years to fund new initiatives. In December 2017, the state received additional federal funding of $5 million for pregnant women, new mothers, and their babies. The State Targeted Opioid Response Initiative (STORI), as the Cures Act funding initiative is called, is primarily administered by DMHAS and is designed to provide service for at-risk individuals with OUD, including veterans, individuals released from incarceration in the last 60 days, and young and older adults. The STORI initiative encompasses a wide range of programs and services, including prevention, treatment, recovery support, and training. The primary treatment component is the development of a fee-for-service initiative providing assessment, outpatient, intensive outpatient, short-term residential, and medication assisted treatment services (MAT).

The STORI was followed by another major congressional funding called the State Opioid Response (SOR) Grant that was awarded in 2018. This federal grant of $21.5 million annually has allowed NJ to continue and to significantly expand its actions. The key objectives of the SOR grant are to increase access to MAT, reduce unmet treatment need, and reduce opioid overdose-related deaths through the provision of prevention, treatment, and recovery activities for OUD, including the abuse of prescription opioids, heroin, and illicit fentanyl and fentanyl analogs. In March 2019, DMHAS received notification of an additional $11.2 million in available funding through the SOR grant, bringing the total federal funding that the state has received since December 2017 to $50.7 million.

Expansion of Treatment for Opioid Use Disorder

In 2018, Governor Murphy proposed and secured a new $100 million investment of state funding to combat the opioid epidemic. The Department of Human Services, the Department of Health, the Department of Children and Families, the Department of Corrections, the Department of Labor, the Department of Community Affairs, and the Office of the Attorney General comprise an interagency group working collaboratively to implement this funding.

Prior to the passage of the Affordable Care Act, SUD treatment and support services generally had limited coverage by private insurance plans and Medicaid coverage did not extend to many lower income individuals. However, after the passage of the Affordable Care Act (ACA) in 2010, benefits for addiction treatment began increasing in the individual insurance market, in addition, Medicaid expansion increased health care coverage for individuals with incomes up to 138% of the federal poverty level. The ACA required insurers to provide SUD treatment services as part of an “Essential Health Benefits” package. Together, these actions significantly expanded access to SUD services.

To ensure that individuals know how to access services, NJ operates a 24-hoursa-day, 7-days-a-week addictions hotline (1-844-ReachNJ or 844-732-2465) where people who have SUD or their loved ones can get immediate help and referrals from live, NJ-based, trained addiction counselors, regardless of their insurance status. The center enlists trained counselors who receive calls, authorize treatment services, and then make a “warm handoff” to treatment providers, ensuring that follow up linkages are made.

New Jersey also has a waiver from federal regulations allowing for Medicaid coverage of residential treatment despite the federal limits on payment for Institutions for Mental Disease (IMD). The waiver has allowed NJ Medicaid to expand coverage for residential drug and alcohol treatment. Initially, Medicaid in NJ provided coverage for withdrawal management and short-term residential services, but it also began to cover long-term residential services. Residential services are critical for those with the most severe OUD, especially for those whose conditions are complicated by a co-occurring physical or mental health condition.

Promoting an Evidence-Based Treatment Model

According to the definition endorsed by the Substance Abuse and Mental Health Administration (SAMHSA), MAT refers to the use of medications (e.g., methadone, buprenorphine, and naltrexone), accompanied by ongoing counseling and cognitive-behavioral therapies. When compared with a traditional abstinence approach, outcomes for MAT in combination with therapy, show greater decreases in use of illicit drugs, better functioning of the individual, reductions in criminal activity and drug-related infectious disease, as well as increases in survival overall. MAT is consistent with the new conceptualization of OUD that is based on a chronic disease model (White, Boyle, Loveland, & Corrington, 2005).

A 2019 expert committee report (Medications for Opioid Use Disorder Saves Lives) found that a majority of individuals who suffer from SUD do not receive any treatment and that only a fraction of this population receives medications for OUD. The report stresses that MAT is essential for some to sustain their recovery, and for many this treatment needs to be long-term <https://www. integration.samhsa.gov/clinical-practice/ mat/mat-overview>. Since a combination of psychopharmacological and therapeutic modalities yields the best outcomes for treating OUD, health care practitioners who offer these kinds of evidence-based therapies can have an important impact in reducing opioid use. In addition, for those individuals who initially began taking opioids for pain, medical marijuana, and CBT for chronic pain can also provide alternative pain management strategies to decrease opioid use.

Unfortunately, there are a few factors that affect proper access to medications for OUD. Methadone as a form of MAT has been available for several decades and shown to be a very effective treatment for OUD. However, it is only dispensed by federally regulated methadone clinics that require almost daily attendance and these clinics are not in every community. Another barrier is the stigma associated with SUD services, especially with taking methadone. Since the two other drugs that are recognized within MAT, buprenorphine and naltrexone, can be given as prescriptions in a physician’s office, treatment there is less stigmatizing. However, federal laws require special training and certification (DATA 2000 Waiver) in order for physicians and other practitioners to prescribe buprenorphine that limits the numbers of prescribers available. Because buprenorphine can be prescribed in physicians’ offices and other outpatient settings, training more prescribers to increase access to this medication is one of the major goals of NJ’s OUD treatment. In addition, relatively few office-based psychiatrists or addiction medicine physicians accept Medicaid, requiring the Medicaid beneficiaries and non-insured people to pay for services out of pocket, which is a hardship. Medicaid had required prior authorization before the drugs could be prescribed but, in a major policy shift, prior authorization for all forms of MAT for treatment of SUD was removed in April 2019. With this critical change in place, practitioners are now more likely to become treatment providers for individuals with OUD that will result in improved access to treatment.

Office Based Addiction Treatment

DHS is also home to the State Medicaid agency (Division of Medical Assistance and Health Services) that, in addition to lifting prior authorization requirements for MAT under Governor Phil Murphy, also launched a major new initiative in July 2019 designed to expand access to MAT. Medicaid based the approach on the “hub and spoke” treatment model, variants of which had been implemented in Vermont and Virginia. In this model, specialty SUD clinics, such as OTPs, serve as the ‘hubs’ and treat patients with more complex needs; meanwhile, the ‘spokes’ are office-based practices and primary care settings in which most patients with more routine needs are treated. The Medicaid agency called the new initiative Office Based Addiction Treatment, or OBAT. The office-based practitioners (e.g., family physicians, psychiatrists, medical specialists, advanced practice nurses) would prescribe buprenorphine and naltrexone, and they would have office-based navigators to assist in making referral arrangements for counseling and community supports. To assist OBAT practitioners, Medicaid increased reimbursement for intake and assessment and funded a new position called the navigator, whose role is to arrange social services and supports for patients and to help monitor their progress.

The OBAT system of OUD services, also referred to as the MATRx, allows a two-way referral of patients with other Medicaid funded providers. Office-based providers can refer patients needing a higher level of medical and/or addiction services to specialty providers (e.g., SUD treatment agencies, Certified Community Behavioral Health Clinics, Federally Qualified Health Care centers, etc.) or to one of two Centers of Excellence (COEs). The state contracted with Rutgers University and Cooper/Rowan University to serve as COEs for the OBAT initiative. In addition to providing MAT services, these centers are available for treatment and consultation referrals of individuals with complex needs, such a co-occurring medical problems and mental health issues. If practitioners without extensive experience prescribing buprenorphine feel they need support to stand-up a MAT practice, the centers are also providing MAT training and will be available to provide mentors to these practitioners.

In addition to the OBAT model, the state has also been promoting ‘low threshold treatment’ programs that provide immediate access to medication in non-traditional settings and sites, syringe exchange programs (known officially as Harm Reduction Centers), and EDs. Funding was just awarded for the provision of low threshold buprenorphine at two syringe exchange programs. EDs in some of the major hospital systems have been dispensing and prescribing buprenorphine for patients with OUDs, frequently after they have been treated for an overdose. The State Department of Health is also allowing paramedics to carry buprenorphine to ease withdrawal symptoms after patients are revived with naloxone. As the number of EDs providing buprenorphine is low, DMHAS is committed to increase those numbers. After administering buprenorphine, some EDs are providing a “warm handoff” to aftercare services to receive ongoing counseling, recovery, and other support services. Immediate access to these services is crucial for many individuals with OUD leaving EDs to prevent relapse and reduce risks of overdose after withdrawal from opioids since their tolerance to opioids might have changed.

A pilot program was established in the Atlantic County jail that provides methadone to inmates using a mobile van from the local OTP and funded by the DMHAS. The state is currently exploring opportunities to assist county correctional facilities to establish MAT programs or to enhance their existing MAT services for inmates. Since these individuals will need follow up services when released to the community, efforts also focus on establishing effective follow-up recovery services.

Peer-based Recovery Support Services

Individuals with SUD seeking recovery and support have traditionally gone to self-help groups or 12-step programs, such as Narcotics Anonymous. While these groups can be effective and are still an important resource, recovery and support services are increasingly being provided by dedicated peer-run recovery support programs. Peer-based recovery support services are designed to deliver nonprofessional, nonclinical help to assist individuals to achieve long-term recovery from SUDs (Bassuk et. al 2016). Unlike with many of the more traditional self-help SUD groups and support programs, these peer services are complementary with MAT services.

Peer specialists are embedded in treatment and support services throughout NJ’s system of care; the peer specialist and navigator roles in the Opioid Overdose Recovery Program (OORP) services are examples of such a program. Recovery support services are based on a “holistic definition of recovery as a self-directed process of change through which individuals improve their health and wellbeing and strive to achieve their full potential” (SAMHSA, 2011). Given the overwhelming evidence that peer-based initiatives are highly effective in recovery-oriented approaches to treatment and care for those individuals with SUD (and mental illness), peer services are funded in a variety of settings:

• Peer-led volunteer-driven Community Peer Recovery Centers (CPRC). These are places where those in recovery can find help, fellowship, and a safe haven. Peer workers provide mentoring, coaching, care coordination, social and recreation activities, life skills and vocational training, support groups, wellness classes, workshops, and other assistance.

• Recovery support services are provided for students at Rutgers University and The College of New Jersey, and an initiative will be expanded to other NJ public colleges, universities, and community colleges to enable the schools to pro- vide recovery and substance-free housing to students in recovery, students at risk of SUD, and students not in recovery, but who choose not to misuse alcohol and illicit drugs.

• Recovery support services specifically designed for opioid-dependent pregnant women are delivered in the Maternal Wrap Around Program (MWRAP) that provides intensive case management and recovery support services for women during pregnancy and up to one year after giving birth. Intensive case management focuses on developing a single, coordinated care plan for pregnant/postpartum women, their children, families, and significant others.

• The Opioid Overdose Response Team (OORT) is a new initiative and involves outreach by teams of peer recovery specialists to individuals who were reversed from an overdose by Emergency Medical Services, but refused transport to the ED.

• A peer curriculum and training is being developed for peers working as volunteers in police departments as part of the Law Enforcement Assisted Addiction and Recovery Referral Program (LEAARRP). This will enable peers to assist individuals to make self-determined choices about their recovery pathway following arrest.

• A recovery support program, for incarcerated individuals with OUD being released to the community, has been implemented to provide continuity of care and comprehensive medical, substance use treatment and social services.

• Partnership for Success (PFS) provides prevention education and services to young people who are involved with the Department of Children and Families - Children’s System of Care. PFS targets underage drinking, marijuana use, and misuse of prescription drugs/ opioids by youth ages 9-20 throughout the state. Prevention strategies include outreach, education, and training services to communities and families.

Provider Training and Public Education Initiatives

Increasing the Number of Buprenorphine Practitioners

With funding from Governor Murphy’s opioid initiative, the state is significantly increasing the number of practitioners who can prescribe buprenorphine to expand to MAT. DATA Waiver Training is expected to be provided to more than 1,000 practitioners. To support primary care practices that are an important component of Office Based Addiction Treatment (OBAT) services, navigator-specific training is also offered since they will be an integral part of these practice settings. Because of stigma, misunderstanding, and discrimination that might affect practitioners working with individuals with SUD and their willingness to provide MAT in their practices, Rowan University was tasked with developing an interactive educational program for physicians and health care professionals addressing stigma.

Reducing the Prescribing of Opioids

The state has several initiatives that have attempted to reduce the prescribing of opioids. The newest initiative is the Opioid Reduction Options (ORO) that was developed to reduce the prescribing of opioids for pain management in EDs. The ORO approach acknowledges that for most painful conditions, opioids should not be the first line of treatment. This is modelled on non-opioid pain management programs in EDs around the country, including the Alternatives to Opioids program at St. Joseph’s Hospital in NJ. Through this initiative, hospitals and their EDs will develop an ORO plan that details the implementation of clinical protocols that call for non-opioid prescriptions, pain management therapies, and other alternative procedures. The goal is to reduce the proportion of patients receiving opioid prescriptions written in EDs to 12% or lower that is significantly lower than the 17% mean rate of opioid prescriptions written in the ED nationwide.

DHS has also been collaborating with DOH on an initiative funded through the governor’s investment to increase access to electronic health records (EHR) of patients receiving SUD care. The SUD Promoting Interoperability Program (SUD PIP) goals include modernizing the EHRs of SUD providers and allowing these to a platform for the sharing of electronic records. A survey of SUD providers indicated this as a critical need in the effectiveness of treatment. Greater sharing of records with healthcare providers will promote better communication and encourage treatment referrals between the SUD providers and the healthcare community.

Developing Opioid Data Dashboards

Having comprehensive real time data related to the opioid crisis is paramount to inform public health policies and practices. Thus, the state developed two websites that provide detailed information about drug-related trends in NJ. The Opioid Data Dashboard on the New Jersey Department of Health (DOH) website (<https://www.state.nj.us/ health/populationhealth/opioid/>. This real-time dashboard allows interactive data visualizations on its display, with data indicators obtained from multiple sources, including the DOH, the Division of Consumer Affairs, the Office of the Attorney General, and other law enforcement bodies. The State’s Attorney General launched the other website, NJ Cares <https://www.njcares.gov/> providing NJ-specific data on opioid and other drug-related overdose indicators, including data on opioid prescriptions, naloxone deployments, drug-related hospital visits, crime statistics, and treatment statistics.

The Future

Efforts must continue to close the treatment gap by providing more timely access to SUD treatment. Prevention efforts must increase to stop the development of an addictive disorder and solid recovery services provided to support individuals from relapsing. The further expansion of low threshold MAT programs, especially in EDs, and of interim SUD services, will certainly help here. Increased integration of SUD services in primary health care settings is also needed, as the evidence shows that individuals with OUD view healthcare settings as more accessible than specialty addiction programs mostly due to the reduced association with stigma and discrimination. Integrated services will help to address the needs of individuals with OUD who have comorbid mental illness and chronic physical health conditions, including chronic pain, cancer, and heart disease that are known to be more prevalent among individuals with SUD. Access to integrated services will be facilitated as the state works to develop a single unified licensing structure for behavioral health and primary health care programs.

To address the sources of fentanyl and heroin that are responsible for the recent surge in overdose deaths, the New Jersey State Police started a task force to coordinate drug interdiction efforts with other agencies. Recent raids on drug mills have had a measurable impact on the supply of these deadly agents, and these raids may have been a factor in the reduction in the number of drug-related deaths in recent months. The public health partnership that has been formed between state health care agencies and the State Police has considerable potential to improve data collection and analysis. Data will be necessary to determine whether anticipated outcomes for the state’s initiatives have been realized. To effectively provide recovery support services, peer specialists need adequate training and follow-up supervision, as well as pathways for peer training and credentialing. To sustain the states multiple OUD initiatives, support for training and for development of the behavioral health professional and peer specialist workforce will be needed.

Conclusion

More than ever before, New Jersey residents with OUD are being guided into evidence-based treatment and are being supported in their recovery. After the initial state efforts were aimed at reducing overdose deaths, New Jersey has focused on expanding access to treatment and recovery supports, and on prevention initiatives. The evidence base for treatment and maintaining recovery from opioid use is especially strong for MAT that includes cognitive behavioral therapies, and peer recovery support, in addition to providing access to safe and effective pharmacotherapy. However, to engage practitioners, individuals with OUD, and the public, education to reduce the stigma associated with OUD is critical.

Many people who struggle with addiction and enter addiction-specific treatments might benefit from either additional or follow-up services that licensed clinical psychologists can offer in private practice settings. Psychologists in private practice might also consider partnering with OUD facilities, primary care offices, and/or EDs to act as valuable collaborators in the treatment of individuals suffering from an OUD. With an array of complimentary changes in place, dramatically better outcomes could be achieved with the focus on long-term recovery and prevention. ❖

References:

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Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) [online]. Retrieved <https://www.cdc.gov/injury/ wisqars/2019/05/30>.

National Academics of Sciences, Engineering, and Medicine. 2019. Medications for Opioid Use Disorder Save Lives. Washington, DC: The National Academies Press. Retrieved from https://doi.org/10.177226/2531/201 9/05/30/19.

The State of New Jersey. NJ Cares. Retrieved from <https://www.njcares. gov/04/25/2019>.

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Continuing Education Instructions: Visit <www.psychologynj.org> and find the CE Homestudy Library link under the Learn tab. This will take you to the online library where you will find the article and evaluation.