Christie’s plan to limit initial opioid prescriptions to 5 days moves forward — despite concerns
Major legislation aimed at tackling New Jersey’s opioid addiction crisis is moving quickly through the Legislature, though some hope it might be changed further before its likely adoption in February.
Gov. Chris Christie called for the bill three weeks ago, in his State of the State. The 38-page bill was quickly and intensively written, then revised by 31 pages of amendments adopted Monday, as Senate and Assembly committee advanced the proposal.
In general terms, the bill requires health insurance coverage for substance-abuse programs, including residential treatment centers. It would also restrict initial prescriptions for opioid painkillers to five days and require doctors to get yearly training on those drugs.
It was the 5-day limit that raised concerns among some lawmakers, though none voted against the legislation Monday. Assemblywoman Amy Handlin voted to abstain.
“I am going to abstain in order to underscore the depth of my concern about punishing law-abiding people in pain and constraining their doctors in unworkable ways for the sins of other over whom they have no control,” said Handlin, R-Monmouth.
Assemblyman Joseph Howarth, R-Burlington, voted for the bill but said he hopes it is refined before the full Assembly considers it. He said he has Crohn’s disease and described his experience after surgery in 2014 to have part of his small intestine removed.
“I was released on pain meds, and I was in no way, shape, able to get back to the physician in five days,” Howarth said.
The bill requires state-regulated health insurers, as well as the state-run health benefits plans for public workers, to provide 180 days of inpatient and outpatient substance-abuse treatment without prior authorization, if a doctor deems it necessary. After four weeks of treatment, though, the insurer can conduct a review of its medical necessity.
Jessica Knowles, national outreach director for the Humble Beginnings Recovery Centers in Cherry Hill, said patients are getting denial letters from their insurers or early dismissal from inpatient care if their addictions are to opiates only.
Robert Budsock, the president and chief executive officer of Integrity House, said insurers used to freely reimburse for treatment coverage until abuses by the treatment industry’s for-profit sector.
“Now what I’ve seen recently is the pendulum swinging in the other direction,” Budsock said. “And what’s happening is that insurance companies are incrementally squeezing the providers that are trying to get approval for residential treatment for an individual that’s addicted to opiates.”
While health insurers monitored Monday’s hearings, they didn’t testify, other than provide written remarks.
A handful of doctors did, including Dr. Scott Waska, chief executive officer of the NJ Society of Interventional Pain Physicians.
“This is a theoretical problem that is not seen in practice nearly to the extent that it’s made out to be,” said Waska, who said the majority of patients and vast majority of doctors deal with opioids responsibly.
Waska said “there’s really very little science” behind the claim that opioid addiction can start within a few days. He said a full 7-day prescription would make more sense, as it would allow patients to go a full week and then see their doctors for a follow-up during regular office hours. Patients who got prescriptions on a Monday or Tuesday could run out of painkillers on a weekend, he said.
“So basically I’ll have patients calling me, and I’m going to tell them, ‘Go to the emergency room. I have no tools available to me, in a legal manner, that allows me to give you a few more tablets that gets you through the weekend,’” Waska said.
“Patients that can get into a car will overload emergency rooms at higher costs and increasing risk of infection. Those that are disabled, elderly, on bed rest, lack transportation or funds will be forced to stay home and suffer,” he said.
Dr. Lewis Wetstein, a Freehold-based cardiothoracic surgeon, said he understands the issue about opioid addictions but that patients will suffer under the 5-day limit. He doesn’t see patients until 10 to 14 days after surgery, when their sutures are ready to come out – and they regain mobility.
“Unfortunately, I produce pain. I’m a cardiothoracic surgeon. In an attempt to cure them, I break ribs. I split their sternum. And these patients are cured, but they’re miserable post-op,” Wetstein said.
Sen. Joseph Vitale, D-Middlesex, said one key is changing pain treatment itself.
“Unless we change the way we treat pain, we’re not going to change the pipeline to addiction,” Vitale said.
Dr. Joseph Costabile, president of the Medical Society of New Jersey, said health insurers will deny alternative pain treatments.
“Part of the stumbling block with all this is the insurance companies,” Costabile said. “I don’t mean to poop all over their parade, but they make it more difficult for us many times to treat patients in a manner that we’ve been trained to do.”
Waska said he has had similar challenges getting insurers to cover what he called “opiate-sparing prescriptions” such as a Lidoderm patch or Lyrica.
“They all cover Percocet because it’s cheap. But they won’t cover a Lidoderm patch, which is a little more expensive, because it’s all about the dollars and cents,” Waska said. “So if I was able to prescribe and use more of the opiate-sparing medications and techniques, it would help me tremendously in avoiding opiates to begin with.”
Assemblyman Craig Coughlin, D-Middlesex, said that wouldn’t be included at this time.
“I can tell you this, that the insurance companies are having a really expensive day today anyway, and we probably don’t need to address that right now,” Coughlin said.
Questions were raised at the Senate health committee hearing about whether New Jersey would have enough treatment available, once coverage is required.
Donald Parker, president of the Carrier Clinic, said it will in the short run but won’t in the long run – unless its universities and health-care industry develop the science of addiction treatment.
“I hope that we take our own moonshot. I’d like to join Joe Biden up there on the moon as he’s working on cancer,” Parker said.
“If we treat it like a disease, fund it like a disease, promote research like a disease, that we will in fact have enough treatment beds because we will have efficient, effective treatment that doesn’t engage our patients in a series of relapses and other maladies,” said Parker, who said his facility is currently engaged in three clinical trials.
The shortage of available beds is exacerbated by communities unwilling to allow facilities in their borders, said Tom Allen of Core Health.
“I can’t tell you how difficult it’s been to open centers. I used to have this saying that it’s easier to open up a gentlemen’s club in this state than to open up a drug and alcohol treatment program, and that’s not far off from the truth,” Allen said.
Vitale said lawmakers are working with Gov. Chris Christie on removing barriers to recovery housing, as the governor called for in his State of the State.
Sen. Robert Gordon, D-Bergen, suggested substance-abuse treatment centers might be reclassified as ‘inherently beneficial’ for zoning purposes.
“It might not be particularly popular with municipal governments. It may be a politically risky thing to do. But it might be a way to expedite approvals,” Gordon said.