Coughlin, Benson & Vainieri Huttle Bill to Help Fight NJ’s Opioid Crisis Goes to Governor

Opioid crisis has killed more than 7,000 people in New Jersey since 2012

(TRENTON) – A measure sponsored by Assembly Speaker-elect Craig Coughlin, Assemblyman Dan Benson and Assemblywoman Valerie Vainieri Huttle to help fight the state’s opioid epidemic received final legislative approval Monday and now heads to the governor’s desk.

The opioid crisis has killed more than 7,000 people in New Jersey since 2012, according to a report by NJ Advance Media. Last year, at least 1,901 people died from opioid overdoses.

“This crisis is killing thousands of New Jerseyans every year and it is only getting worse,” said Speaker-elect Coughlin (D-Middlesex). “We must balance both the needs of patients who rely on these drugs for pain management, and the need to address the opioid misuse and abuse that continues to take a toll on so many families and communities throughout the state.”

“The unfortunate truth is that for many people these drugs are the only option to relieve severe or chronic pain,” said Benson (D-Mercer/Middlesex). “These measures can help reduce the potential for abuse and help prevent the tragic consequences that come with opioid addiction.”

“There is no one solution to this problem. Tackling this epidemic is going to take a long-term, multifaceted approach,” said Vainieri Huttle (D-Bergen). “Taking steps like enhancing monitoring of prescriptions and expanding opioid education to health care professionals who don’t prescribe, but work with these patients can help lessen the risk for abuse, which too often ends in tragedy.”

These steps, couple with other efforts, can help lessen the risk for abuse and prevent the tragic end that comes with an overdose.

The bill (A-5242/5300) would make various revisions to the law to address the opioid crisis.

First, the bill would revise P.L.2017, c.28 to provide that a practitioner must enter into a pain management agreement with a patient prior to the commencement of an ongoing course of treatment for chronic pain with a Schedule II controlled dangerous substance or any opioid, instead of upon issuing the third prescription. The bill would also add a definition of “chronic pain,” which means pain that persists for three or more consecutive months and after reasonable medical efforts have been made to relieve the pain or its causes, it continues, either continuously or episodically.

The bill would also clarify, for the purposes of that law, that when determining whether a patient was previously issued a prescription for opioids; that determination must also include whether the patient also used or was administered a drug or its pharmaceutical equivalent.

Current law requires certain health care professionals to receive training on topics related to prescription opioid drugs. Health care professionals who have the authority to prescribe opioid medications are required to complete one continuing education credit on topics that include responsible prescribing practices, alternatives to opioids for managing and treating pain, and the risks and signs of opioid abuse, addiction, and diversion. This bill would add a similar continuing education requirement for veterinarians.

Health care professionals who do not have prescribing authority but who frequently interact with patients who may be prescribed opioids, including pharmacists, professional nurses, and practical nurses, are also required by existing law to complete one continuing education credit on topics that include alternatives to opioids for managing and treating pain and the risks and signs of opioid abuse, addiction, and diversion. This bill would add a similar education or training requirements for marriage and family therapists, psychologists, athletic trainers, homemaker-home health aides, professionals licensed or certified by the State Board of Social Work Examiners, and professional counselors. The credits required under the bill would be part of a professional’s regular continuing education credits and would not increase the total number of continuing education credits required.

The bill would also revise various statutory provisions related to the Prescription Monitoring Program (PMP), which was established in the Division of Consumer Affairs in the Department of Law and Public Safety. The PMP is an electronic system for monitoring controlled dangerous substances dispensed in or into the state in outpatient settings.

The bill would provide that the Division of Consumer Affairs may make prescription monitoring information available on electronic systems that collect and display health information, such as an electronic system that connects hospital emergency departments for the purpose of transmitting and obtaining patient health data from multiple sources, or an electronic system that notifies practitioners of information pertaining to the treatment of overdoses, provided that the division determines the system has appropriate security protections in place.  An electronic system that is approved by the division to integrate prescription monitoring information may be used by prescribers in hospital emergency departments who are required to access prescription monitoring information under the bill, as well as by other practitioners who are required to check prescription monitoring information when issuing certain prescriptions. The system may further be used to provide certifications that prescription monitoring information is being accessed for an authorized purpose.

Additionally, the bill would add to the circumstances under which a practitioner or other authorized person is required to access prescription monitoring information. In addition to the first time the practitioner or other person prescribes a Schedule II controlled dangerous substance to a new patient for acute or chronic pain, it would be required to check prescription monitoring information:

• the first time a practitioner or other person prescribes a benzodiazepine drug that is a Schedule III or Schedule IV controlled dangerous substance;
• the first time the practitioner or other person prescribes a non-opioid drug other than a benzodiazepine drug that is a Schedule III or IV controlled dangerous substance, but only if the practitioner or other person has a reasonable belief that the person may be seeking a controlled dangerous substance, in whole or in part, for any purpose other than the treatment of an existing medical condition, such as for purposes of misuse, abuse, or diversion; and
• on or after the date that the division first makes prescription monitoring information available on an electronic system that collects and displays health information, any time a practitioner or other person prescribes a Schedule II controlled dangerous substance to a patient receiving care or treatment in the emergency department of a general hospital.

Current law provides certain exemptions from PMP monitoring requirements. The bill would add an exemption for a practitioner who is prescribing a controlled dangerous substance to a patient immediately after the patient has undergone an operation in a general hospital or a licensed ambulatory care facility or treatment for acute trauma in a general hospital or a licensed ambulatory care facility, so long as that operation or treatment was not part of care or treatment in the emergency department of a general hospital, no more than a five-day supply is prescribed.

The bill would also clarify that the director may adopt a regulation to expand the program to require pharmacies to include information about each prescription dispensed for a prescription drug that is not a controlled dangerous substance.

Finally, the bill would allow a physician assistant or an advanced practice nurse to, under certain circumstances, dispense narcotic drugs for maintenance treatment or detoxification treatment. The bill would also provide that a physician assistant or advanced practice nurse, under certain circumstances, may make the determination as to the medical necessity for services for the treatment of substance use disorder, as provided in P.L.2017, c.28 (C.17:48-6nn et al.), and may prescribe such services.

The bill was approved 67-0 by the Assembly and 37-0 by the Senate on Jan. 8.