N.J. can stop some people from overdosing and dying, ex-governor says. All we have to do is act. – NJ.com

By Jim McGreevey

In New Jersey, there were 12,000 overdose deaths substantially from heroin and fentanyl in the past six years, 3,000 overdose deaths last year, and 900 overdose deaths so far this year.

The correlation between those addicted and those in the criminal justice system is high. If you are incarcerated, there’s a high probability you are addicted; if you are addicted, there is a high probability you are court involved. And race plays a significant role in what happens: statistically, you are more likely to be imprisoned, as opposed to receiving treatment, if you are African American or Latino.

Let’s look at hypothetical inmate Michael, who is being released from serving the maximum of his sentence; Michael has no housing, no employment, no license, no identification (save his DOC card), and no Medicaid card to access health care.

While we could detail the circuitous and labyrinthine route that Michael has to travel to access a plethora of federal and state programs, often with conflicting requirements, suffice to say, it’s laborious. Yet, arguably in the face of New Jersey’s skyrocketing overdose deaths, Michael’s unresolved acute healthcare needs offer the most dire prospect. Tragically, Michael is 129 times more likely than the average American to die of an overdose death in the first two weeks after release.

Let’s look at Michael’s clinical profile: Michael has an 80 to 90 percent chance of having a chronic disease, whether diabetes, asthma, high blood pressure, an infectious disease, including HIV and Hepatitis C.

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The New Jersey Department of Corrections has an entire prison dedicated to treating inmates with addictions.

There’s a high probability of Michael having mental illness, twice the national average. Over half of inmates meet the criteria for mental illness. Individuals suffering from mental illness are 4.5 times more likely to be arrested than the general population. Nationally, between one-third and one-half of inmates do not receive any treatment for their chronic conditions during incarceration.

And, most probably, Michael is an addict. It is estimated that 70 percent of the inmate population is addicted – and a 24 to 36 percent probability that Michael is addicted to heroin/fentanyl.

Statewide, our prisons are striving to be part of the addiction treatment solution in large measure due to an innovative partnership between the Departments of Corrections and Rutgers Behavioral Health; yet, due to the scope of funding, less than 10 percent of inmates with a history of serious addiction are being provided treatment with, for example, buprenorphine (a form of Opioid Addiction Treatment (OAT) proven to cut the risk of overdose death in half and double the chance of recovery).

But while Michael may have accessed heroin behind the wall, his tolerance has appreciably waned and his cravings have skyrocketed, greatly exacerbating the risk of relapse, overdose, and death. In fact, there’s a 75 percent chance of Michael having an opioid addiction relapse within three months after release, and there’s less than 10 percent chance that Michael will enter treatment after being released from prison. The risk of overdose death for Michael is exceptionally high.

What must we need to do?

1. First, when Michael is released from prison today he is not being given a Medicaid card to access health care. That needs to change. Our clients are being released from prison on Thursday, unable to access suboxone or vivitrol, overdosing and dying by Monday.
2. Second, OAT must be accessible for walk-in clients like Michael at designated local pharmacies. For example, except Rutgers, there are few physicians in Essex County who will administer outpatient OAT to our clients (licensing, reimbursement and tortious exposure remain substantial challenges).
3. Third, we need to establish a “Hub and Spoke” template in our counties that identifies a “Hub” center of treatment, including OAT, with the “spokes” of supportive community and reentry services. Today, families struggle to discern treatment “best practices,” funding streams, and community support.
4. Fourth, state integration and planning throughout all levels of addiction treatment, funding, and sharing of patient clinical information is a must. Our present “system” isn’t broken, it does not exist. NJ needs a coherent treatment blueprint with clear, definable objectives, linkages, and outcomes. NY does it far better.
5. Fifth, licensing must be systematically streamlined. Separate licenses are required to provide types of addiction treatment. While other states move to integrate care to address medical, behavioral, and addiction needs in a coordinated way, New Jersey’s regulatory and licensing systems often bar both providers from offering integrated care and patients from receiving it. Currently, there are three separate licensing offices (addiction, medical, and mental healthcare), administered by two separate agencies. The fragmentation results in the inability of providers to bill for more than one type of service during a patient’s single visit.

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The opioid problem is getting worse in N.J. Sen. Joseph Vitale said he will introduce a bill changing the treatment system.

Given the high incidence of comorbidity among the addicted reentry population, we must tackle these significant barriers to provide accessibility to necessary care by simultaneously addressing mental, medical, and addiction needs, if we are to save lives.

If we do not do so, we can only be described as complicit, or at least apathetic, to the deaths of those addicted persons – the vast majority of whom are our young adults, our children.

Jim McGreevey, a former New Jersey governor, is the chair of the New Jersey Reentry Corporation.

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