The New Jersey Heroin Epidemic: Addiction, Treatment, and the Law
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The rate of heroin overdose in New Jersey is over 3 times the national average.  In New Jersey heroin is also the leading cause of accidental death, according to NJTVonline.org. Opioid prescriptions have nearly tripled between 1991 and 2011.  Although you can trace the crisis’ roots to the 1980s, when pharmaceutical firms creating oxycodone, hydrocodone, and other pain narcotics claimed these drugs carried minimal risk for addiction.

We have known for years, that these and other Schedule II drugs are, in fact, highly addictive. To stave off the horrors of withdrawal and feed the cravings caused as these drugs change the brain’s chemistry, more people have sought and used heroin. It’s cheaper, more potent, and thanks to increased drug trafficking into the US by cartels, easy to get.

According to the CDC, in 2015, heroin deaths surpassed the toll from prescription opioids. The CDC and other experts link this explosion to the significant rise in painkiller use in the late 1990s and early 2000s, and tighter restrictions on painkiller prescriptions—driving demand to the illegal street market.

In 2017, New Jersey passed one of the most aggressive laws to combat the opioid epidemic.  Many people become addicted to heroin as a result of using prescribed Schedule II drugs.  Due to this the law was designed to better help doctors control and monitor prescriptions of dangerously addictive drugs and require insurance companies to cover patients seeking treatment for addiction.

The law also has enacted stricter regulations to hopefully reduce the number of patients who become addicted to legally-prescribed drugs and who, when those prescriptions expire, seek less-expensive options—like heroin.

The challenge of this devastating epidemic is that Schedule II prescription drugs significantly alter their brain chemistry to the point of dependency. It becomes physically impossible to function without the relief that these drugs bring.  That, coupled with the increase in the number of opioid prescriptions, has contributed to driving the New Jersey heroin epidemic to such dangerously high levels.

The law:

  • Requires health insurance coverage for substance use disorders and that insurers, the State Health Benefits Program, and the School Employees’ Health Benefits Program adhere to certain coverage requirements for treatment of substance use disorders.
  • Regulates opioids and other prescription drugs.
  • Requires certain notifications when prescribing Schedule II controlled dangerous substances to control acute or chronic pain.
  • Requires specific health care providers receive training on topics associated with prescription opioid drugs.

But what is a substance use disorder? The law uses the same definition as provided by the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders:

Recurrent use of drugs/alcohol that causes clinically and functionally significant impairment.  This includes such as health problems, disability, and failure to meet major responsibilities at work, school, or home. A diagnosis of substance use disorder is based on evidence of impaired control, social impairment, risky use, and pharmacological criteria.

Inpatient/Outpatient Treatment

With this law, insurers must provide unlimited benefits for inpatient/outpatient substance use disorders at state-approved in-network facilities. These services must be provided by licensed physicians, psychologists, or psychiatrists, health care professionals, and licensed/certified substance use disorder providers.

When someone needs treatment, his or her insurance company won’t require prior authorization before providing 180 days per plan year of treatment. The facility must notify the insurer of the treatment plan and admission within 49 hours. If there’s no in-network facility available right away, the insurance company must provide exceptions.  This is to ensure the patient’s treatment begins within 24 hours.

This law also waives pre-payment of medical expenses during those 180 days; except for the regular plan co-payments, deductibles, or co-insurance. If a patient requires treatment beyond 180 days of the plan year, the healthcare team may need to provide medical proof of the need for additional treatment and obtain authorization from the insurance provider.

If a patient is admitted for treatment, the first 28 days of treatment are automatically covered and don’t require authorization. The law also mandates additional coverage—including medication-assisted treatments—for up to six months, if deemed medically necessary.

Prescription of opioids and Schedule II controlled substances

Doctors cannot prescribe more than a five-day supply at the lowest-possible effective dose for people suffering from acute or chronic pain. Prior to giving patients this prescription, doctors must also:

  • Take and document the patient’s medical history, including experiences with non-opioid medication and non-pharmacological pain management approaches and substance abuse history (if any).
  • Conduct and document a physical examination.
  • Create a treatment plan that identifies, as much as possible, the cause of the patient’s pain.
  • Access relevant prescription monitoring information under the Prescription Monitoring program.
  • Limit the prescription to five days as determined by dosage amount and frequency.

If a patient still requires this medication after five days, the doctor can issue additional prescriptions.  However only after consulting with the patient a second time.

The law contains other regulations and requirements for increased education and training. The law’s authors recognize that prescribing opioids aggressively has led to the epidemic.  However that the law won’t just solve the problem. You can read more about this law here.

The New Jersey heroin epidemic is complex and involves patient and medical professional education, educating the community and law enforcement, reducing drug trafficking, and improving access to addiction treatment.

But what happens when someone is arrested and charged with making, distributing, possessing, or using heroin? The laws are strict and people who possess heroin—even a tiny amount—are guilty of a third-degree felony.  Penalties can include imprisonment up to five years, a fine of up to $35,000, and a mandatory loss of their driver’s license for six months.

New Jersey Heroin Laws

Sale, manufacture, or distribution of heroin and its derivatives

  • .5 oz. or less: crime of third degree, up to 5 years imprisonment, up to $75,000 fine
  • .5 oz. to 5 oz.: crime of second degree, 5 – 10 years imprisonment
  • Over 5 oz.: crime of first degree, 10 – 20 years imprisonment, and up to $500,000 fine
  • Selling within 1000 feet of a school: fixed prison term, up to $100,000
  • Selling to minor or pregnant female: double penalties

If you or someone you know has been arrested or charged with heroin possession or sale, we can help you. 

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