Last year, New Jersey recorded the first year-over-year decrease in fatal drug overdoses in at least a decade, state records show. Experts attribute the decline to regulatory changes that made treatment more accessible during the COVID-19 pandemic.
Some 2,892 people are suspected to have died from drug use in 2022, according to the Office of the Chief State Medical Examiner, down from 3,124 the previous year. It’s the first time the death toll dipped below 3,000 in five years. Another 230 likely died this way in January, the data shows.
While the death toll — driven largely by fentanyl and other highly toxic substances mixed into street drugs — remains high, addiction providers said policy revisions that allowed for the use of telemedicine and take-home medications made it easier for drug users to get help. Efforts to distribute naloxone, the opioid-reversal agent, generally known by the brand name Narcan, have also saved lives, they said.
“What we see is that treatment works,” said Dr. Petros Levounis, chair of the psychiatry department at Rutgers New Jersey Medical School. Levounis runs one of the two state centers of excellence for medication-assisted treatment, or MAT, the gold-standard for opioid addiction. “Relaxing the regulations around prescribing [MAT] is curbing the epidemic,” he said.
Fatal overdose deaths continue to climb nationwide, but the number of fatalities in 2022 was below what had been predicted, said Levounis, the president-elect at the American Psychiatric Association. “That gap is absolutely unprecedented,” he said.
Michael Litterer, vice president of the RWJBarnabas Health Institute for Prevention and Recovery, agreed the changes are having a real impact but said more work is needed, especially in some specific communities. “Obviously any reduction in overdose deaths should be celebrated,” he said. “But I don’t think we can lull ourselves into thinking we are succeeding when we are only succeeding among some populations.”
Partial success
While drug-related deaths may be declining overall in New Jersey, they are increasing among Black people and seniors of all races, according to the medical examiner’s office. Fatal overdoses increased 28% among Black New Jerseyans between 2021 and 2022, the data shows, and 31% for those age 55 and older, trends that have emerged in multiple states in recent years. Black people are also less than half as likely as white people to have received treatment, according to federal figures.
Robert Budsock, president and CEO of Integrity House, a Newark nonprofit that has been treating addictions for nearly 50 years, said the 2022 data “can be viewed as a plateau as we continue to work towards meaningful reduction in the number of state-wide and nationwide overdose deaths.”
‘Can you imagine if someone had to stand on line every morning to get their insulin? And when they got there, they were urine-screened and if their blood sugar was too high, they didn’t get it?’ — Michael Litterer, RWJBarnabas Health Institute for Prevention and Recovery
Budsock and others also credited the wider availability of naloxone, which New Jersey has distributed among emergency responders, schools, libraries, homeless shelters and the public through statewide giveaways. Naloxone doses are now available to those age 14 and older at pharmacies in New Jersey for free, without a prescription.
Experts said even more lives could be saved if the pandemic-era treatment changes are made permanent, something the federal Substance Abuse and Mental Health Services Administration is now considering. If approved, the changes — the first major reforms in decades — would give providers greater flexibility as to where and how they prescribe medications.
Methadone clinics
Perhaps the biggest change proposed is for methadone clinics, where participants traditionally had to show up in person every day to be screened and get medicine, if they didn’t test positive for opioids. Instead, patients could get a week’s worth of methadone to go.
“Evidence from the past two years demonstrates safety, as well as high patient and practitioner satisfaction with take-home doses of methadone. This is principally because unsupervised doses of methadone allow individuals the opportunity to engage in employment or other activities that are supportive of recovery and longer term community involvement,” SAMHSA wrote in a description of the changes, which are now subject to public input.
Treatment providers, who have been frustrated by the historic inflexibility of federal methadone regulations said these changes are significant. “Can you imagine if someone had to stand on line every morning to get their insulin? And when they got there, they were urine-screened and if their blood sugar was too high, they didn’t get it?” said Litterer, with RWJBarnabas Health, comparing the methadone treatment protocols to those for diabetes. “It’s unconscionable.”
‘We should treat it like we do everything else. There is absolutely nothing special about addiction.’ — Dr. Petros Levounis, Rutgers New Jersey Medical School
Litterer and others said an even bigger change is likely to result from the elimination of what providers call the X-Waiver, which required MAT prescribers to take additional courses and receive special federal approval to dispense buprenorphine, the most common form of addiction medication. That requirement — which also capped the number of patients a MAT provider could treat at one time, essentially eliminating buprenorphine’s use in larger clinic settings that are more likely to serve low-income patients and people of color — was removed as part of the federal budget negotiations, SAMHSA recently announced.
The hope is this will expand the number of MAT providers, creating more opportunities for people to get treatment. “It’s a giant leap forward,” Litterer said.
Levounis, who has taught over 100 buprenorphine-prescribing classes at Rutgers, also praised the federal government’s decision. “This was a real barrier” to treatment, he said of the waiver. “A well-trained physician should be able to learn about addiction and buprenorphine and be able to prescribe it in the same way” as they do other medications, he said.
Reducing stigma
The additional requirements for buprenorphine prescribers added to the stigma around addiction, Levounis explained. “There’s this perception that there is something very dangerous about buprenorphine,” he said. “You need special training, a special license, a special waiver, special this, special that. That is the opposite of what we want people to understand.”
“In 2023 my mantra is, ‘addiction schma-diction,” Levounis said. “We should treat it like we do everything else. There is absolutely nothing special about addiction.”
The New Jersey Department of Human Services, which oversees addiction services, also supports the changes. “Removing the need for the X-waiver is key in allowing a greater number of individuals to access medications, as part of their treatment for opioid use disorder,” said Eva Loayza-McBride, deputy communications director for DHS. “It will now be much easier to integrate this service into multiple settings, including primary care.”
New Jersey has worked hard to expand its pool of MAT prescribers, with the two centers of excellence — in Camden and Newark — helping to train and support providers in their work. There are now nearly 3,400 credentialed providers statewide, Loayza-McBride said, up from just over 2,300 in 2019. The state expects this number will now grow, she said.
Ending the X-waiver “removes the notion that the treatment of opioid use disorder with buprenorphine is a highly specialized, complex, or dangerous activity, when it is not,” Loayza-McBride said.
The state also supports making the pandemic-era prescribing changes permanent, according to Loayza-McBride, which she said have expanded access to treatment and helped reach populations that had previously been left out. She said DHS could not be sure the increased flexibility during COVID-19 led to the decline in drug-related deaths, but “we do note that the changes created a much easier pathway for individuals to access treatment, specifically medication to support them on their pathway to recovery.”
Interview with Lilo Stainton
— Editor’s note: This story has been updated to note Dr. Petros Levounis’ position as president-elect at the American Psychiatric Association.
