DECRIMINALIZATION POSITION

 

The National Council on Alcoholism and Drug Dependence – New Jersey (NCADD-NJ) has clarified its stance on the question of decriminalization of all illicit substances. While the agency does not endorse the legalization (government allowing, providing or regulating) of drugs. NCADD-NJ does support their decriminalization. The following policy statement explains that NCADD-NJ does not believe anyone should receive either a criminal sentence/record nor incarceration for the possession or use of drugs. Criminal proceedings should be replaced by assessments and a referral to treatment when appropriate. 

NCADD-NJ STATE BUDGET TESTIMONY (Oct. 1, 2020 through June 30, 2021)

Due to the coronavirus epidemic, along with the lack of any financial assistance from the federal government, Garden State lawmakers resorted to adopting an interim state Budget for the period of July 1, 2020 through Sept. 30, 2020. In Sept., the Assembly and Senate Budget Committees accepted written public comments on fiscal year proposals covering Oct. 1, 2020 through June 30, 2021. Our agency, as well as, a number of our volunteer Advocates, submitted comments. The following is the NCADD-NJ organizational testimony:

 

The National Council on Alcoholism and Drug Dependence – NJ (NCADD-NJ) is an incorporated non-profit organization operating in the Garden State since 1982. NCADD-NJ works in partnership with, and on behalf of, individuals, families, and communities affected by alcoholism and drug dependence, to promote recovery. We have been working for more than thirty five years to reduce the stigma and discrimination associated with addictive illness. We have been strong advocates for public policies that increase access to quality treatment and recovery services.

 

NCADD-NJ also operates the Substance Abuse Initiative and Behavioral Health Initiative (SAI/BHI) to help implement the Work First New Jersey welfare-to-work program funded by the NJ Dept. of Human Services. The goal of the SAI/BHI is to eliminate addiction as a barrier to employment. The NJ Division of Family Development funds our Family Violence Option (FVO) project. The purpose of the FVO program is to afford protection to domestic violence victims who are receiving General Assistance or Temporary Assistance to Needy Families help.

 

We also provide substance misuse assessments for youth under the supervision of the NJ Juvenile Justice Commission. This assessment further includes level of care placement recommendations.

 

The present day description of the one-two punch of COVID-19 and addictions is as a crisis wrapped in a crisis. The coronavirus pandemic has exacerbated the psychological factors that are involved in substance use behavior. The medical journal PSYCHIATRY RESEARCH (Aug. 18, 2020) noted that the social isolation, economic hardship, worry, fear, and disruption of normal activities have resulted in increased drug misuse among those with existing addiction disorders, along with a rise in use among former abstainers.  Combine this with capacity limitations, growing waitlists, and reduced hours at many addiction treatment programs and one sees what could have long been expected – a nearly 20% increase of drug overdoses, according to a University of Baltimore study last month. Overdose deaths in New Jersey were averaging around 3,000 per annum for the past several years before COVID-19. It is blatantly obvious the State must find the resources to, not just maintain past levels of funding, but to enhance the response to an escalating need.

 

We are encouraged to see the Dept. of Human Services continue to do more with less as, among other initiatives, it has sustained its naloxone (opioid overdose reversal drug) free distribution to individuals, police depts., libraries, and homeless shelters effort, along with the launch of a program to train EMS first responders on interacting with patients following treatment from a suspect opioid overdose and linking patients to needed services.

 

A final observation – In a report issued by the American Medical Association’s (AMA) Opioid Task Force (July 28, 2020), it was determined that, although opioid prescriptions decreased in the last year, the use of illicit drugs has gone up. This leaves for a future debate the question of whether restricting access to prescribed and regulated medications, rather than decreasing drug misuse, isn’t instead, driving up customers for the illegal trade? In the Governor’s proposed nine-month Budget, he included anticipated revenue from an “opioid tax.” Our belief is that this may well have the unintended and ironic consequence of hurting the effort to mitigate the worsening drug addiction crisis in our state. Two of the drugs utilized as part of a medication assisted treatment (MAT) regimen to treat addictions, are methadone and buprenorphine. Both contain a certain amount of opioid medication (the former 10% and the latter 85%). A tax on their use will certainly make them more expensive, if not entirely inaccessible. Attaching extra costs to therapies that help people to heal seems never to be a good idea. Making it more burdensome for individuals seeking relief from chronic pain and addiction disorders would be foolish.  

A NEED FOR A DRUG CZAR ?

 Would the struggle against the crippling effects of addictive behavioral disorders benefit from a consolidating of initiatives coordinated by one person or office? Does the Garden State need a Drug Czar (my term)? There are three bills pending in the state Legislature that would significantly center addiction prevention, treatment and recovery services under one roof. All three are presently receiving committee consideration.

 

* Assembly Bill 2124 and Senate Bill 2170 would establish an Office of Alcohol and Drug Use Disorders Policy to oversee, direct and coordinate resources, funding and data tracking with all State Departments with regard to the prevention and treatment of alcohol and drug disorders. The Office would be allocated within the Dept. of the Treasury but would be independent of the Dept. and would report directly to the Governor. It would review County Annual Alliance Plans and distribute grants. It would evaluate provider performance and enforce contract compliance. The Office would take over most of the functions of the Governor’s Council on Alcoholism and Drug Abuse. An Executive Director would be appointed by the Governor with the consent of the Senate.

 

* Assembly Bill 3364 would create an Office of Alcohol, Drug and Tobacco Use Control Policy in the Dept. of Health. It would develop a strategic plan to reduce use, oversee the collection of data related to youth use, identify the best municipal youth programs, and develop recommendations to improve the safety and effectiveness of acute pain treatment. The Office would apply for grants to fund itself.

 

* Senate Bill 2079 would create the Office of Coordinated Substance Use Control Policy and Planning in, but not of, the Dept. of Human Services. It is intended that it would be independent of DHS control. The Governor would appoint the Executive Director and his/her Deputy, with Senate consent. The Office would develop a strategic plan, coordinate and oversee all substance use control activities in all state Departments, law enforcement, and local governments, make compliance recommendations, provide agency budget recommendations, audit and evaluate agency performance, biennially review existing laws and regulations to determine consistency with the Strategic Plan, serve as spokesperson for Executive Branch substance use policies, administer appropriate grant programs, assume some of the responsibilities of the current Governor’s Council on Alcohol and Drug Abuse including review of County Annual Alliance Plans, examine extant statutes and make recommendations, hire, appoint, transfer agency staff to implement the Strategic Plan, assign funds among agencies, control the use of agency monies, and operate a hotline to assist the public.

 

Even if it is determined that either of these proposals (or some combination thereof) would improve on the present state of things, would New Jersey government have the will to make it happen? Would the monies be found to carry out this reform in a meaningful way? An argument could be made that every state department should be ready to engage in activities, within its bailiwick, that would help the cause. However, in the world of turf politics, how much authority and funding can it be reasonably expected that extant bureaucracies would voluntarily surrender? And can’t you just hear the howl that would be emitted from the hallowed halls of county and municipal governments when the big toe of state government is seen to be encroaching on its territory?

 

If this organizational shuffling makes effective sense, then like so many meaningful changes, it will have to be a priority of people seeking long-term recovery and their allies in order to get it enacted.

 

Ed Martone

Policy Analyst

ON MY MIND

 We are now one quarter through the 2020/21 state Legislative Term and a number of bills have been introduced to deal with the struggle of people seeking to attain, and maintain, long-term sobriety. There was hope that we were beginning to realize a modicum of success in 2019 that could be built upon in the New Year. A number of significant reforms were enacted; the Governor and most in  the Legislature were supportive of our recommendations; $100m had been pledged in the next Fiscal Year for addiction services; and overdose deaths had been reduced three percent below the previous year (for the first time in years). Then COVID-19 hit hard. The virus, and the resulting lockdown exacerbated problems of depression, anxiety, drug misuse, and overdose deaths. At a time when more folks needed treatment, many providers had to place limits on the number of patients admitted, or closed their doors altogether. Additionally, the state Budget is hemorrhaging billions of dollars and monies for addiction services have been largely frozen. Politically, attention has been rightly focused on the viral outbreak.

 

The challenge before us is to re-aim the spotlight on solutions to mitigate the damage left in addiction’s wake, that impedes recovery. Concentrating on public policies that can contribute to securing a path to wellness is one way in which people seeking healing, and their allies, can make a needed difference.

 

The following are some pending proposals being followed in the NJ Senate and Assembly:

 

A.970/S.2259 – Requires public schools to administer written student screenings for depression and other behavioral issues

AJR178/SJR85 – Recognize August 31 of each year as “Overdose Awareness Day”

A.4221 – Mandates that the Office of Information Technology establish a centralized, one-stop website resource guide to assist people in navigating the State’s mental health and substance use disorder service systems

S.805/A.3004 – Permits individuals with drug distribution, or intent to distribute, convictions to be eligible for General Assistance (welfare) benefits

S.1109 and S.1753 – Examines the issue of health insurers’ network adequacy

A.683 – Creates the office of Behavioral Health Ombudsperson

S.151/A.672 – Limits the release of a patient’s private information to insurance carriers

A.275/S.1112 – Reduces court-ordered fines owed by a drug or alcohol-dependent person upon the completion of a treatment program

A.2684/S.1073 – Authorizes public libraries to maintain a supply of opioid antidotes and permits emergency administration of an opioid antidote by a librarian or another trained library employee

A.3364 and S.2079 and S.2170/A.2124 – Creates the Office of Alcohol, Drug, and Tobacco Use Control Policy (Drug Czar)

S.1763/A.2280 – Prohibits certain substance use disorder treatment facilities from paying fees, commissions, or rebates to any person to refer patients to a particular facility (patient brokering)

S.1788/A.2642 – Requires hospitals to inquire whether patients have a substance use disorder and establishes protocols for providing or referring to treatment

S.508/A.3158 – Mandates that public and nonpublic secondary schools annually conduct written or verbal substance use screening on all students using a particular screening program (SBIRT)

S.892/A.2649 – Requires nursing homes to provide training to staff in behavioral health issues

A.3284 – Requires pharmacies to maintain a minimum stock of opioid antidotes

A.271 – Changes the name of “Drug Court” to “Recovery Court”

A.3295/S.1121 – Increases Medicaid reimbursement rates for certain evidence-based behavioral health services to Medicare levels

S.1731/A.2295 – Mandates the curriculum in medical schools include instruction in the treatment and management of opiate-dependent patients that meets the minimum training requirements established for physicians to be authorized to prescribe narcotic drugs

A.2269/S.1844 – Requires hospitals to include a warning in patient discharge papers concerning the risks of addiction and overdose associated with opioid medications

A.1059 – Requires institutions of higher education to maintain a supply of opioid antidotes and permits the emergency administration of an opioid antidote by a campus medical professional or trained employee

A.677 – Authorizes Overdose Prevention Centers (safe injection sites)

S.877/A.809 – Mandates state and county correctional facilities to develop strategic plans to provide peer counseling and peer health navigators to support the treatment of substance use disorders

S.1968 – Provides tax credits to employers who hire people in recovery from substance use disorder

S.1969 – Includes substance use disorder on a list of disabilities that qualify a student for state special education and related services

A.3941 – Provides for funds received from opioid litigation or settlements to be dedicated for use in financing substance use disorder prevention and treatment services

S.2323/A.3869 – Requires the issuance of a prescription for an opioid antidote to anyone receiving a prescription for an opioid medication

 

Ed Martone

Policy Analyst

When the Titanic Meets the Iceberg

As of this writing, the world’s concern is understandably and correctly focused on the coronavirus and the COVID-19 disease it begets. The lack of either a vaccine or a cure, along with its blitzkrieg-like spread onto every continent, is precisely the extreme crisis that draws all attention, to the exclusion of nearly all other problems. This is no less true of our elected and appointed leaders who have had to put almost all else aside in order to deal with this worsening emergency. Nevertheless, addictive illnesses have not gone away during this time; and some proposals have moved partially through the state legislative process in the past few weeks, including:

* A.809/S.877 – Requires jails and prisons to develop plans to provide peer counseling and peer health navigators to support the treatment of substance use disorders. S.877 was approved on a unanimous Health Committee vote and sent to the Appropriations Committee. Its companion, A.804, is in the Law and Public Safety Committee.

* S.491 and S.241 – are two bills that would reform some of the workings of Drug Court. Specifically, they would permit more offenses to be eligible for admission, liberalize the expungement process, and restrict Drug Court’s authority to revoke a person’s participation in the program, or to disallow certain individuals to be admitted in to the Intensive Supervision Program (ISP). Both of these legislative proposals were released by the Senate Judiciary Committee, and will now travel to the full Senate for a Floor vote.

Beyond these – over five thousand bills have been introduced in to the 2020/21 Legislative Term. The following are only some of the measures NCADD-NJ is monitoring:

* A.3004/S.805 – Permit people with drug distribution, or intent to distribute, convictions to be eligible for General Assistance (welfare) benefits

* S.1109 and S.1173 – Examine the issue of health insurers’ network adequacy

* S.151/A.672 – Limit the release of a patient’s private information to insurance carriers

* A.275/S.1112 – Reduce court-ordered fines owed by a drug or alcohol-dependent person upon the completion of a treatment program

* A.2684/S.1073 – Authorizes public libraries to maintain a supply of opioid antidotes and permits emergency administration of an opioid antidote by a librarian or another trained library employee

* A.3364 and S.2079 and A.2124/S.2170 – Establishes the Office of Alcohol, Drug, and Tobacco Use Control Policy (Drug Czar)

* S.1763/A.2280 – Prohibits certain substance use disorder therapy facilities from paying fees, commissions, or rebates to any person to refer patients to a program (patient brokering)

* S.1788/A.2642 – Requires hospitals to inquire whether patients have a substance use disorder and establish protocols for providing or referring to treatment

* A.3158/S.508 – Mandates that all public and nonpublic secondary schools annually conduct written or verbal substance use screening on all students using a particular screening program

* S.892/A.2649 – Requires nursing homes to provide training to staff in behavioral health issues

* A.3284 – Requires pharmacies to maintain a stock of opioid antidotes

* A.271 – Changes the name “Drug Court” to “Recovery Court”

* S.1121/A.3295 – Increases Medicaid reimbursement rates for certain evidence-based behavioral health services to Medicare levels

* A.2295/S.1731 – Mandates the curriculum in medical schools include instruction in the treatment and management of opiate-dependent patients that meets the minimum training requirements established for physicians to be authorized to prescribe narcotic drugs

* S.1844/A.2269 – Requires hospitals to include a warning in patient discharge papers concerning the risks of addiction and overdose associated with opioid medications

* A.1059 – Requires institutions of higher education to maintain a supply of opioid antidotes and permits the emergency administration of an opioid antidote by a campus medical professional or trained employee

* A.677 – Authorizes Overdose Prevention Centers (safe injection sites)

For more information on these bills, go to www.njleg.state.nj.us

In the midst of the uncertainty and dread caused by the coronavirus, NCADD-NJ staff and volunteer Advocates will continue to direct their work, and the concentration of the policy-makers, on repairing the devastation caused by behavioral health disorders.

   

ONE LONG EMERGENCY

The following is the testimony I submitted to the NJ Senate and Assembly Budget and Appropriations Committees on March 10 and March 18, 2020 addressing the Fiscal Year 2021 State Budget.

The National Council on Alcoholism and Drug Dependence - NJ is an incorporated non-profit organization operating in the Garden State since 1982. NCADD-NJ works in partnership with, and on behalf of, individuals, families, and communities affected by alcoholism and drug dependence, to promote recovery. We have been working for more than thirty five years to reduce the stigma and discrimination associated with addictive illness. We have been a strong advocate for public policies that increase access to quality treatment and recovery services.

NCADD-NJ also operates the Substance Abuse Initiative and Behavioral Health Initiative (SAI/BHI) to help implement the Work First New Jersey welfare-to-work program funded by the NJ Dept. of Human Services. The goal of the SAI/BHI is to eliminate addiction as a barrier to employment.

The NJ Division of Family Development funds our Family Violence Option project. The purpose of the FVO program is to afford protection to domestic violence victims who are receiving General Assistance or Temporary Assistance to Needy Families help.

We also provide substance misuse assessments for youth under the supervision of the NJ Juvenile Justice Commission. This assessment further includes level of care placement recommendations.

NCADD-NJ encourages the Legislature to support Governor Phil Murphy’s proposal of $100m dedicated to fund the prevention and treatment of addiction disorders, along with the recovery of its survivors. This would represent the third year in a row of a commitment in this amount. Earlier investments have slowed and somewhat reversed the scourge of opioid misuse, however, the level of devastation created by this illness remains unacceptable. A diminution of our efforts to fight it, will only ensure too many more victims.

2020 will be the first full year of parity implementation. Last year the Legislature and Governor endorsed a new law requiring health plans sold in this state to document full compliance with established principle that coverage for medical and surgical treatment, be on a par with that for behavioral care. The NJ Dept. of Banking and Insurance was tasked with monitoring and enforcing the parity statute. We urge the Legislature and Governor to fully fund the Department’s assignment to inform the public, treatment providers and insurance carriers of the new provisions of the parity law, along with the need to retain some additional staff to carry out the Department’s enforcement mandate.  

The NJ Dept. of Human Services has announced a number of initiatives in the coming year to combat addiction disease. All of these are supported by NCADD-NJ, and the Legislature is asked to include them in the state Budget. These include:

• Following up on the statewide distribution last June 18^th of 32,000 free dosages of the opioid overdose reversal drug, naloxone – in 2020, the Department intends to give out 53,000 doses to police officers, 2000 to homeless shelters, and 400 to public libraries.
•          The REACH NJ hotline is being re-tooled. Among the changes will be the provision that a caller receive live assistance, rather than a recording. Billboard and television ads are now up promoting the revised hotline.
•          $1.7m is being allotted to certain counties as part of the “Innovation Projects” effort, with, hopefully, more to follow.
•          It is anticipated that reimbursement rates will be raised for integrated care management and residential treatment slots.
• Initially, $7.8m has been made available to county jails across the state to initiate opioid therapy in jails and to connect individuals to community-based care post release. This pilot should be expanded upon, in order that every lock up facility has medication assisted treatment, Medicaid enrollment, and post release aftercare programs in place.

NCADD-NJ has been pleased overall with the refined response to the opioid epidemic of the past two governors and members of the Senate and Assembly. The changed thinking of our policy makers toward addiction as a public health, rather than a criminal justice problem, has allowed for a more sophisticated and effective approach toward solutions.

REBOUND, RESTORE

The problem of addiction and, in particular, the carnage created by the opioid epidemic, continued to present itself as the worst public health issue of the past few years. The crisis garnered much of the public’s elected representatives’ attention, and the state Legislature and Governor enacted a number of mostly positive proposals in the law by the recently concluded 2018/19 Legislative Term.

The following were signed in to law:

* S.626 – Disallows health insurance plans to deny coverage due to preexisting conditions

* A.5248 and A.5506 – Requires health insurance plans to cover essential behavioral health services

* A.5501 – Mandates a continuation of health benefits dependent coverage until child turns 26 years of age

* S.824 – Eliminates driver license suspension for first DUI offense, but mandates the installation of an ignition interlock device

* A.2031 – Enhances enforcement of parity laws that mandate that health plans reimburse for behavioral healthcare on a par with the manner in which coverage for medical and surgical services is offered

* S.2861 – Requires health curriculum for public school students in grades kindergarten through 12 to include instruction on mental health and substance disorders

* A.3292 – Requires that opioid prescriptions include a warning sticker advising patients of the risks of addiction and overdose

* A.4744 – Requires the N.J. Dept. of Human Services to ensure that medication assisted treatment benefits in the Medicaid program are provided without the imposition of prior authorization strictures

* A.5823 – Removes the prohibition on voting by persons convicted of indictable offenses who are on probation or parole

* A.268 – “P.I.C.K. Awareness Act;” authorizes the issuance of special support recovery housing license plates

A number of criminal justice, penal reform and expungement measures were signed in to law, including:

* A.3979 – “Dignity for Incarcerated Primary Caretaker Parents Act”

* S.2055 – Permits incarcerated individuals to receive student financial aid

In almost every instance, people in recovery and their families provided their uniquely valuable perspective in crafting these policies.

Ed Martone, 

Policy Analyst