Issue Background

Prescription Drug Abuse

READ MSNJ's ACTIONS AND REPORT ON THE OPIOID CRISIS

SPECIAL ALERT:

The Governor signed fast-tracked legislation that requires prescribers to check the PMP (first time and quarterly thereafter) for virtually all DEA scheduled drugs, effective immediately. A prescriber must check for 1) ANY opioid for pain 2) schedule III and IV benzodiazepines and 3) any scheduled drug, if there is suspicion of abuse or diversion. The bill also removes the exemption for emergency departments to check the PMP before prescribing these medications. Read MSNJ’s summary of the new law.

NEW LEGISLATION

A bill is quickly moving through the Legislature in lame duck. The bill addresses our major interpretation concerns with S-3, in that removes “third prescription” as a threshold for chronic pain treatment protocols. But, the bill also adds new PMP look-up requirements that are inconsistent with the focus on heroin and fentanyl use. It would require a PMP check for ALL opioids, even the proper alternatives to Schedule II drugs. And, it would add a requirement for benzodiazepines, which is a sharp change of focus from opioids. Find MSNJ’s letter on ongoing issues here.

As a reminder, the FDA issued a warning about combining opioids and benzodiazepines. 

New Updates:

Camden County is joining the legal fight against the opioid epidemic - but with an unprecedented argument. The county is filing a racketeering lawsuit against several pharmaceutical companies, as well as naming three individuals of the Sackler family, which owns Connecticut-based Purdue Pharma - the maker of OxyContin - as defendants. Read more.  

AmeriHealth New Jersey has changed its benefits policy to include a no-cost share offer to its members for Narcan and Naloxone. Read more

The FDA recently revised labeling for some prescription cough and cold products to limit pediatric use. After safety labeling changes are made, these products will no longer be indicated for use to treat cough in any pediatric population and will be labeled for use only in adults aged 18 years and older. Read more.

New UnitedHealthcare Opioid Coverage Policy

New to Therapy Short-Acting Opioid Supply and Daily Dose Limits for UnitedHealthcare Community Plan and UnitedHealthcare Commercial Plans - Effective March 1, 2018. Read more.

Physicians now have a secure way of reporting patients or other prescribers, whether is a pattern of addiction or criminal activity.

Drug Abuse Bill Signed, February 15, 2017

 The Assembly passed AND THE GOVERNOR IMMEDIATELY SIGNED legislation that implements the Governor's plan to increase insurance coverage for addiction treatment (unlimited benefits with guaranteed coverage of medically necessary treatment for 6 months without prior authorization) and limit opioid prescriptions for acute pain to 5 days.

Read more:

Additional Resources:

The Board of Medical Examiners has posted guidance and a sample patient agreement to help physicians comply with the new opioid law. Find the BME information, including regulations

Report patient access issues as a result of this law to MSNJ by emailing info@msnj.org.

 
 
 
NEW INFORMATION ON THE NEW JERSEY PRESCRIPTION DRUG MONITORING PROGRAM MOBILE APPLICATION.
 
IMPORTANT: NEW INFORMATION ON THE PRESCRITPION MONITORING PROGRAM AND DEA REGISTRATION
Please read a guidance document on the Prescription Monitoring Program, which has a new vendor. There are also new regulations. Please contact Mishael Azam with any questions at 609-896-1766, ext. 203.
 
PMP Update
The NJPMP converted to a new platform, Appriss AWARxE, in November 2016.  Any prescriber who had not accessed the old system, Optimum/O-Tech, at least once since October 2015 or who did not have an unique email address associated with her old registration, was not migrated over to the new system. Thus, those prescribers need to re-register since the registration process utilizes an unique email address.  The new registration process uses a validation process to check a prescriber’s professional license, DEA and State CDS Registration numbers and if it matches the State’s file, the prescriber will be automatically approved for access to the NJPMP.

In addition, the NJPMP’s mobile app for Android and Apple iOS is temporarily disconnected due to the platform conversion.  The program is working diligently with the vendor to re-deploy the mobile app. Stay tuned.

Storage and Disposal

A new law requires physicians who dispense controlled substances to provide disposal information has taken effect. This is a narrow requirement only for physicians who dispense CDS (which cannot exceed a 7 day supply). Please read notice instructions. MSNJ urges all prescribers to discuss safe storage and disposal with ALL opioid patients. Pharmacies are now required to share this information.

 
Pharmacy Red Flags
Please see this video and this article for insight into pharmacy scrutiny of opioid prescriptions. Pharmacists are not only allowed to scrutinize prescriptions, but face penalties and fines for dispensing opioids indiscreetly. These resources aim to reduce prescriber frustrations and pharmacy denials.

Project Medicine Drop

Project Medicine Drop is intended to raise awareness of the prescription painkiller abuse problem in New Jersey and the proper disposal of these medications. Please post the appropriate county flyer in your office:

Atlantic Gloucester Ocean
Bergen Hudson Passaic
Burlington Hunterdon Salem
Camden Mercer Somerset
Cape May Middlesex Sussex
Cumberland Monmouth Union
Essex Morris Warren

Feds Announce Expansion of Drug Drop Off Locations. More information to follow.

Advocacy

MSNJ Urges Congress to Pass Bill Supporting State PDMPs
MSNJ joined organized medicine, pharmaceutical companies, laboratories and patient groups in a letter to Congress thanking the House for passing NASPER, the federal program providing support for state Prescription Drug Monitoring Programs (PDMPs), and urging the Senate to do the same. MSNJ urged our Senators to vote for the bill this week. AMA issued sensible opioid prescribing guidelinesAnd, President Obama sided with physicians on opioid restrictions. Read more.
 
Drug Abuse Comments
MSNJ, AMA and others have filed comments on proposed CDC guidelines on opioid prescribing. Read our comments. See AMA's comments.

In addition, MSNJ has filed comments with the New Jersey Division of Consumer Affairs regarding regulations proposed to implement the 2015 Prescription Monitoring Program law.

Information about Prescribing Naloxone

You can now prescribe naloxone if you think your patient may be in danger of overdosing. See the BME waiver here 

Per new law, a health care professional prescribing or dispensing an opioid antidote to a patient shall ensure that the patient receives patient overdose information.  This information shall include, but is not limited to: opioid overdose prevention and recognition; how to perform rescue breathing and resuscitation; opioid antidote dosage and administration; the importance of calling 911 emergency telephone service for assistance with an opioid overdose; and care for an overdose victim after administration of the opioid antidote. The documents below are compliant with this provision of the law.

  • Intake form:  This could be adapted to any practice and integrated into a patient chart.
  • Overdose emergency procedures:  This is a one page document with pictures that allows the prescriber/dispenser to quickly and easily explain the necessary information to the patient and give them to take with the naloxone.  It can be used as is or adapted.
  • Naloxone administration guide:  A one page guide with pictures that allows the prescriber/dispenser to quickly and easily explain how to administer naloxone and can be given to the patient to take with them.
  • An article which highlights the naloxone training done by the South Jersey AIDS Alliance (model for physicians)
  • Q&A created about the law for medical professionals
  • An instructional video to learn how to administer naloxone.
  • Take the American Medicine Chest Challenge...in 5 easy steps.
  • AMA’s guide to increasing access to Naloxone.
  • Newsletter on Naloxone Administration

Best Practices

Events/Education

  • ONDCP Archived Webinar: Addressing Opioid Overdose Use Disorder in Hospitals – December 20, 2016
  • ONDCP Archived Webinar: Innovative Approaches for Addressing Opioid Overdose and Opioid Use Disorders in Hospital Emergency Departments – August 5, 2016
  • AMA Education on Opioid Misuse & Prevention: Check out these webinars to learn how you can help your patients manage their chronic pain, while preventing opioid abuse.
  • MSNJ member, Dr. Shore, and prominent NJ addiction expert, Dr. Baxter participated in a panel entitled Stigma As A Roadblock to Recovery at a historic event this week. Governor Christie hosted an event to discuss drug addiction issues and reduce stigma for this disease. See press coverage.
  • MSNJ participated in the fifth Do No Harm CME event for physicians. Almost 200 physicans attended the event. MSNJ is a sponsor of the event series, along with the Partnership for a Drug-Free New Jersey, the New Jersey Office of the Attorney General, the federal Drug Enforcement Administration and others. The CME series is a part of MSNJ's focus on drug addiction prevention and reduction. See the flier.

Media

Christie Announces Expansion of Prescription Drug Monitoring Program to Other States

New Jersey Consumer Affairs Director Calls New Jersey Prescription Monitoring Program a Vital Tool in the Fight Against Opiate Abuse

Bills Targeting Overdoses from Heroin and Opioids Go Far Beyond 'Just Say No'

NJ Lawmakers Unveil Package of Bills Aimed at Curbing Heroin, Pill Abuse

Inside NJ's Historic Push to Tackle Heroin Epidemic

N.J. Heroin Legislation Lauded by Many, But Questions, Gaps Remain

Surgeon General Releases New Report on Alcohol, Drugs, & Health

HHS Works to Expand Medication-Assisted Treatment (MAT) to Address Opioid Epidemic

Drug disposal awareness:

Physician disciplinary action:

Naloxone news:

Other drug abuse news:

Resources

Federal Resources

FY 2017 DFC Funding Opportunity Announcement (FOA)
The Office of National Drug Control Policy (ONDCP) and the Substance Abuse and Mental Health Services Administration (SAMHSA) are accepting applications for Fiscal Year (FY) 2017 Drug-Free Communities (DFC) Support Program grants. Click here to access the FY 2017 DFC FOA on the SAMHSA grants website or here for Grants.gov.

Addiction Medicine Officially Recognized as Medical Subspecialty
For the first time ever, the more than 850,000 physicians who are certified by a member board of the American Board of Medical Specialties (ABMS) will be able to sit for an exam to obtain certification in the sub-specialty of addiction medicine. 

Physicians who are certified by any of the 24 Member Boards of the ABMS and have substantial experience in the field of addiction medicine are eligible to apply to take the examination during the first five years that the exam is offered. Thereafter, a one-year addiction medicine fellowship will be required to take the examination. There are already 44 accredited addiction medicine fellowship programs.

Review Course: To help physicians prepare for the exam, the American Society of Addiction Medicine will be conducting a review course for physicians in Dallas, Texas, from July 27-29. Physicians interested in certification or recertification can find more information on the course and a link to the course registration site here.

Certification Exam: The first certification exam will be offered in fall 2017, with anticipated application dates in April and May 2017. Details can be found here.

CDC Modernizes Pain Management and Prescription Guidelines with New App
The Centers for Disease Control and Prevention (CDC) introduced a free Opioid Guideline App that allows users to access the agency’s recommendations on pain management and opioid treatment. The purpose of the app is to provide healthcare professionals and patients with quick reference materials on the prescription opioid overdose crisis and help them make informed clinical decisions. Features include a useful and intuitive Morphine Milligram Equivalent (MME) calculator for drugs such as hydrocodone, transdermal fentanyl, and other opioids. Additionally, the app contains summaries of key guideline recommendations, a glossary of terms, and an interactive motivational interview feature.