Waging the war on drugs

The battleground may be much closer than you think as experts tell parents to lock up their medicine cabinets

UNION COUNTY — The dramatic surge in heroin and opiate abuse continues to rise in suburbia, and it’s getting worse. There is little doubt among officials that New Jersey is in the midst of a drug epidemic and while officials have waged war on this problem, the question of will it be enough still hangs in the air.

Last week the New Jersey Division of the Drug Enforcement Administration, or the DEA, issued an advisory to the public about the high purity level of heroin circulating in the state. It is yet another indication that drug dealers are winning the battles.

Latest lab results revealed the purity level of heroin in New Jersey now averages 58 percent, an increase of 12 percent from 2011, a level that has raised alarm among drug enforcement officials.

Usually, typical purity levels of street heroin average about 40 percent in New Jersey compared to the New England area, for example, where the level hovers around 15 percent.

“This is one of the highest purity levels in the United States,” said Drug Enforcement Administration Special Agent in Charge Carl Kotowski in the statement, noting that those who begin their journey into addiction using prescription opiates more often than not end up buying street heroin because it is cheaper and easy to obtain.

Novice users, unaware of the strength of street heroin, end up overdosing because they have no idea heroin purity levels are
so high.

Kotowski pointed out that in 2013, there were 557 heroin related deaths in New Jersey, all fueled by this street drug making its way from South America via the sea ports in Newark, Elizabeth and Philadelphia areas, in addition to international airports and the interstate highway system passing through New Jersey.

In 2011 843 people died from drug related overdoses compared to 1,294 in 2013. A report issued by the “Task Force on Heroin and Other Opiate Use in New Jersey’s Youth and Young Adults,” identified heroin and opiate use as the number one health care crisis confronting the state. In fact, heroin deaths have now surpassed the number one cause of death in New Jersey, according to the report.

This report pointed to a five-year increase of more than 200 percent in the number of admissions to licensed or certified treatment programs for prescription drug abuse and a 700-percent increase over the last decade.

Couple that with a 2014 state report “Confronting New Jersey’s New Drug Problem,” a strategic plan to address the burgeoning heroin-opiate epidemic among adolescents and young adults. The report noted this epidemic is a new kind of drug crisis, one affecting and killing countless young people previously thought to be at low risk of addiction.

However, it is important here to understand 70 percent of those who abused prescription pain relievers received them from friends or relatives.

National Drug Enforcement Administrator Michele M. Leonhart mentioned in a report recently that it is possible the increase in overdoses is the direct result of heroin now being used at a younger age.

This agency stressed that many prescription opiate users turn to heroin as a cheaper and more easily obtained alternative to prescription drugs, but have no clue about purity levels or that they are playing Russian roulette with their lives.

The latest figures recently released by the state for 2013 show there were 8,300 admissions to state licensed or certified substance abuse facilities, a 400-percent increase in substance abuse treatment admissions for people abusing prescription drugs. Prescription drugs were implicated in the deaths of more than 700 New Jersey residents in both 2011 and 2012, according to statistics released by the state medical examiner.

Alarmingly, 40 percent of those admitted for treatment for heroin or opiate addiction involved young adults 25-years-old or younger. More importantly, state officials have determined prescription opiate abuse is the “gateway” drug that leads directly to heroin use.

Over the last several weeks LocalSource has presented strong evidence that heroin and opiate abuse is no longer isolated to the streets of Newark or Camden.
The raw and tragic stories of young adult addicts living in the suburban communities of Cranford, Westfield, Union and Mountainside made it painfully clear that heroin and opiate abuse drag not only abusers into a living hell, but also their families.

In some cases, the lives of these people will never be the same. Racked with guilt, confusion and pain, they often bear the scars of a war their child tried to battle alone and lost.

In an effort to ensure their report understood how this heroin and opiate epidemic was affecting families across the socioeconomic board, the state task force conducted hearings that brought forth not only experts in the field but grieving parents who gathered enough strength to share their painful and unexpected journey into the world of opiate and heroin addiction.

“The bitter lessons learned by these courageous mothers and fathers informed our recommendations on how to address the myriad of problems that confront our system for apportioning substance abuse treatment services,” the state report noted.

State officials on the task force also agreed there had to be an expansion of substance abuse treatment services and opportunities in order to address the distinctive needs of adolescents and young adults who become opiate and heroin dependent.

It was glaringly apparent, though, that after all the research and history has been laid out, thousands of young adults are stepping into this black hole every day, unaware they could be signing their own death certificate.

Much has been done in recent years to respond to this emerging crisis, the state report pointed out, but while these steps are critically important, there is much left to do. The task force found that in order to truly address this crisis, public discussion about establishing a sensible drug policy needs to be broadened and amplified.

New Jersey already has in place a comprehensive community-based substance abuse prevention infrastructure that features active and engaged municipal alliance programs. The Division of Mental Health and Addiction Services also have a statewide network of 17 regional coalitions that delivers prevention information to families, children, adolescents and older adults in all 21 counties.

However, the state report stressed multiple times that this current crisis demands an even greater degree of coordination and collaboration in order to convince young people to stay off the road to addiction.

“Consider in this regard that some stakeholders focus on overdose fatalities. Others are principally concerned with suicides. The common denominator, of course, is that young people are dying,” the task force said in its report, adding “this fact, more than any other, creates an urgent need to re-examine, re-invent and re-launch the states substance abuse awareness and prevention efforts.”

The state also said the single most important goal set forth in their report is to deter the misuse of opiate medications and heroin, but they were aware this has to be done through a variety of mediums.

This included working with doctors to ensure better prescribing practices and identify ways to deter inappropriate prescribing and dispensing.

“It is regrettable, but undeniable, however, that despite our best efforts at prevention and deterrence, some young people will not heed our warnings and will find themselves in need of rehabilitative services,” the state report went on.

The state has intensified efforts to shut down “pill mills” and prescription fraud schemes. They suggested that as pharmaceutical companies develop new ways to manufacture products that are more abuse-resistant, there will be a spike in demand for treatment. But, officials are not wearing blinders, by any means.

“Otherwise, ironically, our efforts to reduce the supply of illegally-diverted prescription painkillers will force even more untreated addicts to turn to street heroin. It boils down to simple choice: we can step into the breach and meet the coming demand for prescription abuse treatment services, or we can leave it to profiteering drug traffickers to meet an increased demand for heroin, knowing full well that they are ready and willing to do so,” the task force said in its report.

The task force also was realistic in its approach to this epidemic, pointing out that while they had to set realistic objectives, they were more than aware of the immense challenge they faced and how much could actually be done to combat this opiate and heroin epidemic.

“Consistent with the prayer that is known so well to persons in recovery, we need the serenity to accept the things we cannot change, the courage to change the things we can and the wisdom to know the difference,” they noted, adding there may well be some aspects of the prescription drug and heroin abuse problem the state will not be able to solve, at least in the short term.

The state recognized New Jersey had to be part of a nationwide communications exchange platform that tracked abuse and diversion, or their efforts would face a roadblock that was insurmountable.

The National Association of Boards of Pharmacy has established such a platform, the NABP PMP InterConnect, which allows participating state pharmacies across the nation to be linked so they can securely share data across state lines.

Twenty-four states currently participate in this communications exchange, with two more expected to be sharing data by the end of this year. As of March 2014 pharmacies are now required to upload prescription information to NJPMP once a week.

The program is not without faults, though. The way the system is set up currently, when prescribers, pharmacists or law enforcement official’s access NJPMP in order to get the prescription histories of someone suspected of opiate abuse or criminal diversion, the data is not up to date and actually could be up to seven days old.

In other words, the information has a significant likelihood of not only being incomplete but also from an intervention and investigative perspective, “relatively stale.”

New York and Oklahoma already require pharmacies to report prescription information to their PMPs in real-time, while at least six other states mandate pharmacies report updated information every 24 hours.

Based on this, the task force also strongly recommended the state needs to immediately examine its technology for issuing prescriptions.
Nevertheless, despite efforts to update security features involving the prescription pads doctors and other tools prescribers use, industrious forgers and counterfeiters find ways to defeat these safeguards.

Task force members felt the state should, in conjunction with stakeholders involved in prescribing and dispensing opiates, move toward the use of electronic scripts. However, this is not foolproof either.

Meanwhile, Gov. Chris Christie’s Council on Alcoholism and Drug Abuse recently launched a statewide advertising awareness campaign entitled “Addiction does not discriminate.” This campaign is geared toward fighting the opiate abuse epidemic by showing no one is immune to this deadly drug problem facing the state.

The campaign also provides state residents with information on preventing abuse and recognizing when loved ones are at risk for heroin and opiate addiction, along with finding treatment.

The advertising campaign, running through September, represented the first time recommendations by the task force were put into action.
The ads feature a composite face representing the fact that prescription drug abuse and heroin addiction transcend demographic groups. They also bear the message “Your medicine cabinet could be a gateway to heroin,” along with the web address, knowaddiction.nj.gov.

This website connects New Jersey residents directly with resources about addiction and addiction related issues, including how to help prevent family members, friends, students, patients, co-workers and others from experimenting with prescription drug abuse; how to identify the signs an individual is at risk of addiction or is hiding a drug problem; and how to find addiction treatment.

“No one experiments with drugs thinking they will become addicted. This disease is insidious that way,” said Jennifer Velez, Commissioner of the New Jersey Department of Human Services, which oversees drug prevention and treatment programs for adults statewide.

“This ad campaign serves as a critical wake-up call. We know from our work in this area that addiction affects people of all ages, races and socioeconomic backgrounds,” she added.

The initiative also challenges state residents to take the “Five-Step American Medicine Chest Challenge,” which includes taking inventory of prescriptions and over the counter medicine; securing the medicine cabinet; disposing of unused, unwanted and expired medicine; taking
medication exactly as prescribed and talking to children about the dangers of prescription drug abuse.

“Over the last five years we have prosecuted 65 people, including five doctors and two pharmacists for prescription drug trafficking,” said U.S. Attorney Paul J. Fishman, adding that while the state is committed to an aggressive law enforcement approach to this problem, “we will never arrest our way out of this epidemic.”

“Children and young adults today not only face local drug dealers peddling diverted pain pills on street corners, our unprepared loved ones can be supplied by their best friends at school, unsecured medicine cabinets in our households, and even some medical professionals who choose to traffic pills for profit. Opiate abuse is extremely dangerous and destroyed families in our cities, our suburbs and rural communities,” the U.S. attorney said.

“The ‘Right Prescription for New Jersey’ campaign will serve as an invaluable avenue for all citizens to protect themselves and their loved ones through education, preparation and awareness,” Fishman added.

The U.S. Attorney also noted the state is calling on residents to look at their medicine cabinets “through new eyes,” and as an access point for potential misuse and abuse of over-the-counter and prescription medicine by young people.

“Our hope is that this initiative, by raising awareness about the dangers of abusing prescription drugs and reducing the availability of potent drugs that lead kids down a path to addiction, will help stem the tide of the epidemic of prescription drug abuse that is claiming 40 American lives a day,” said Angelo M. Valente, executive director of the Partnership for a Drug-Free New Jersey.

The schools are also mandated by the New Jersey State Board of Education to present a curriculum designed to prevent children from abusing chemical substances and alcohol. However, this avenue is not a foolproof method by any means.

According to the task force that addressed this issue head on, given the fast pace at which the substance abuse culture is changing, by the time a curriculum is adopted by local school districts and introduced in the classroom, it may already be out of date.

Recently Trinitas Regional Medical Center in Elizabeth held a summit on painkiller addiction and its relationship to heroin abuse. This seminar took a hard approach to this soaring heroin and opiate epidemic by including local law enforcement agencies, members of the medical community, prevention advocates, families of addicts and community agencies. Each took aim at identifying what methods could be taken to reduce painkiller addiction in communities throughout the county and state.

Union County Acting Prosecutor Grace Park reported at this seminar the county sees between 30 and 50 deaths each year as a result of prescription painkiller abuse. The number, while startling, continues to rise annually because of the access young adults have to prescription drugs like OxyContin, Vicodin, Percocet and Percodan.

New Jersey has received mixed reviews when it comes to treatment options for heroin and opiate addicts. In 2011, the state had 361 substance abuse treatment facilities, an increase from 341 in 2007, according to the Substance Abuse and Mental Health Services Administration.

The number of beds, however, is woefully inadequate for the number of addicts seeking treatment. According to state figures an estimated 72,000 addicts will seek in-patient and out-patient treatment, up from two years ago when that number was 68,000.

Addicts in need of treatment longer than a month turn to other states, including Florida and Pennsylvania, where 23 percent of facilities in each state provide long-term treatment.

Meanwhile, there are families in towns throughout Union County living a nightmare because they never knew the ticking time bomb of opiate abuse and subsequent move to heroin was as close as their medicine cabinet.

“The line between legitimate medications and illicit street drugs has become blurred and there is a disturbing new relationship between the doctor’s office, pharmacy and back-alley drug pusher,” the state report stressed.

One father learned this lesson in the most gut-wrenching way, one that even a year later causes him to break down sobbing.

“As parents we are all naive. We think because we raise good kids in a good neighborhood with nice houses that they will be insulated from this heroin epidemic, but we were all wrong. I learned that the night I had to identify my 19-year-old son at the morgue,” said John, 41, of Rahway, breaking into heart-wrenching sobs that he was unable to control.

“If I only knew, if only I realized the prescription pain medication in our medicine cabinet would be the route to my son overdosing on heroin and dying, do you think I would have left it there? God help me, I killed my own son and I have to wake up every morning knowing I could have done something to help him,” he said, adding “I’m begging parents to look in their medicine cabinets and take out every pain prescription. If you don’t, you could end up at the morgue like I did and it will be too late.”