Doctors hear horrors of New Jersey's epidemic of prescription-drug abuse
New Jersey doctors had already been forewarned that prescription-drug addiction has been ravaging the state – yesterday, they learned the grim details.
Prescription drugs were implicated in the deaths of more than 700 state residents in both 2011 and 2012, according to statistics released by Dr. Roger Mitchell, the New Jersey assistant state medical examiner.
He contrasted that number with the 75 deaths caused by Hurricane Sandy last year.
"The question is, are we stronger than this storm?" Mitchell said of the overdose epidemic as he spoke yesterday at an event for heathcare professionals held at Hackensack University Medical Center.
The number of drug deaths in the state rose from 843 in 2010 to 1,027 in 2011 and 1,188 in 2013. The number of deaths caused by prescription drugs alone over the three years varied from 402 in 2010 to 470 in 2011 and 460 in 2012, while the instances in which deaths were caused by a combination of prescription and illicit drugs rose from 180 in 2010 to 231 in 2011 and 262 in 2012.
The opioid pain reliever oxycodone trails only heroin in the number of deaths it factors into in New Jersey, with 337 of the drug deaths in 2011 involving oxycodone either alone or in combination with other prescription or illicit drugs, according to Mitchell.
"Now mixed drug use is the norm," Mitchell said, noting that the percentage of drug deaths involving prescriptions reached 69 percent in 2011 before dropping to 62 percent in 2012. However, the preliminary figures for 2013 show that percentage appears to have risen again, he said.
Oxycodone is a bigger problem in New Jersey than what Mitchell saw in Houston, where he served as a medical examiner from 2007 to 2011.
"Being in Houston, I saw Soma (a dangerous muscle relaxant), I saw hydrocodone, but I didn't see oxys," said Mitchell, who has performed more than 1,200 autopsies in his career.
He noted that the prescription drug deaths are more geographically dispersed across the state than illicit drug overdoses, which are more concentrated in densely populated areas. Of the oxycodone victims, 87 percent were white and 66 percent were male. Mitchell noted a geographic cluster of prescription-drug deaths around Hackensack.
"This is where they're coming and getting their prescription drugs, right, so you have to understand it." he told the audience. "If you know that it's all around you – the deaths that are occurring – that's going to allow you to be a little bit more vigilant."
He challenged the doctors to work together with law enforcement to reduce the scourge of prescription addiction.
A state task force is scheduled in mid-November to release a report that will recommend steps aimed at reducing deaths from heroin and other opioids, including prescriptions.
One idea that has been supported by some officials in the state attorney general's office would require all doctors in the state to participate in the state's prescription monitoring program (PMP), a database which tracks all cases in which controlled dangerous substances are prescribed by doctors and dispensed by pharmacies.
This data can be useful to doctors in catching patients who have prescription addictions or who serve as fronts for criminal organizations, officials say. It is also used by law enforcement in tracking doctors who overprescribe dangerous drugs. But doctors' participation rates in the program, which is currently voluntary, has been running at about 10 percent of eligible providers.
"We know you're trying to save lives," First Assistant Attorney General Thomas Calcagni said, calling on doctors to join the PMP. "And we don't believe you're the problem, but we desperately need you to be part of the solution."
U.S. Attorney Paul Fishman noted that, 20 years ago, he kept unused prescription painkillers in a medicine cabinet after receiving them for leg surgery due to a sports injury. He didn't have children at the time.
"If I were to make that same decision today (with children and babysitters having potential access to the cabinet) ... it would be one of the stupidest things I had ever done," Fishman said, pointing to a major contributor to prescription misuse – unsecured prescriptions. Fishman noted that he's prosecuted doctors for illegal prescriptions and said that the economic costs of prescription abuse are high.
Dr. Steven M. Marcus, medical director of the state poison center and an audience member, noted that the federal government has spent much more on law- enforcement efforts as part of the war on drugs than it has spent on public health efforts to prevent drug addiction.
Marcus also suggested that every home should be required to have a locked medicine cabinet, in the same way that fire detectors are required.
"Why don't we have proactive people looking at primary prevention?" Marcus asked.
Steve Adubato, who moderated a panel at the symposium, took an informal poll of the audience, pointing out that some doctors weren't registered for the PMP. He challenged them to do so.
Dr. Rudolph Willis of Irvington said he hadn't registered because he rarely prescribes dangerous drugs, but having heard the information during the symposium, he planned to register.
Dr. Joseph P. Valenza, director of pain management at the Kessler Institute for Rehabilitation, noted the importance of balancing the effort to reduce addiction with the need to treat patients with chronic pain.
To not provide medication to these patients "is to leave people so that they want to die every day," said Valenza, an audience member.
The symposium, titled "Do No Harm" in reference to an ethical principle taught to all medical students, offered doctors continuing education credits required by the state. It was hosted by the attorney general's office and other agencies, including the Partnership for a Drug-Free New Jersey, the state division of the U.S. Drug Enforcement Administration and the federal High Intensity Drug Trafficking Areas program.
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