Attorney General Christopher S. Porrino and the Division of Consumer Affairs today unveiled an online information hub to help health care practitioners and their patients understand and comply with New Jersey’s new opioid prescribing regulations, including the widely-publicized five-day limit on initial prescriptions for opioids to treat acute pain.
The new regulations, aimed at combatting the opioid epidemic, establish standards for practitioners who prescribe opioids for acute and chronic pain.
To help doctors, dentists and other practitioners navigate the new prescribing landscape, the Division of Consumer Affairs has created the “Prescribing for Pain” information hub on its website to answer commonly asked questions about the regulations and provide guidelines on how to follow them.
Patients, too, can consult the website for guidelines on the new rules. In addition to providing answers to questions commonly asked by patients, the guidelines present a series of questions patients should ask their prescribers before taking opioid medications, including possible side-effects of opioids, how the drugs could affect someone with a history of substance abuse, and what non-opioid options are available to help with pain relief.
The regulations, which implement legislation signed into law by Governor Chris Christie in February, apply to opioids and other controlled dangerous substances (“CDS”) prescribed to treat chronic and acute pain. The five-day limit, however, applies only to opioids prescribed to treat acute pain, which is defined as pain that a practitioner reasonably expects
to last only a short period of time. The regulations do not apply to opioids used in cancer or hospice care, in treating substance abuse, or in long-term care facilities.
In addition to the five-day limit, the rules require an initial pain prescription to be for the lowest effective dose of an immediate release medication. No less than four days after issuing the initial prescription, a practitioner may issue a subsequent prescription for pain but must first consult with the patient – in person or by phone – and determine that the additional supply is necessary and appropriate to the patient’s treatment needs, and does not present an undue risk of abuse, addiction, or diversion.
The new rules include other requirements of prescribers, including a mandate that prior to prescribing opioids, practitioners must discuss with the patient the risks associated with the medication, including the risks of addiction and overdose.
Although the procedure for creating or amending regulations usually takes six months and includes a 60-day public comment period, the law allows for emergency rulemaking when there is an imminent peril to the health, safety or welfare of the public.
According to the State Medical Examiner’s Office, more than 1,300 people were lost to drug-related deaths in New Jersey in 2014. In 2015, that number spiked to nearly 1,600. Statistics to date suggest the drug-related death toll for 2016 will eclipse the 2015 figure.
The regulations imposing prescribing limits on opioids, which were formally adopted by the prescribing boards this week, are part of a holistic approach to the drug crisis being led by the Attorney General’s Office.
Other initiatives within the Division of Consumer Affairs include:
* Increased Crackdown on Indiscriminate Prescribing – Under the push to rein in problem prescribers, the Division is disciplining physicians at a record rate. In 2016, an unprecedented 31 physicians saw their practicing or prescribing authority revoked, suspended or otherwise restricted for allegedly putting the public at risk by indiscriminately prescribing highly-addictive narcotics.
* Emergency Ban on Counterfeit Fentanyl – Intervening to stop an imminent threat to public safety and health, the Director of the Division of Consumer Affairs executed an Emergency Order banning the manufacture, distribution, sale, and possession of seven illegal knock-offs of the highly addictive opioid fentanyl. The Order added the seven “fentanyl analogs” – derivatives of the regulated prescription drug - to the list of Schedule I Controlled Dangerous Substances (CDS) in New Jersey, subjecting them to the strictest level of state control. Prior to the ban, the drugs, which are produced in clandestine labs in other countries, were not recognized as CDS by the U.S. Drug Enforcement Administration (DEA), stranding them in a legal grey zone that permitted them to be peddled in New Jersey with virtual impunity.
* Expansion of the New Jersey Prescription Monitoring Program (NJPMP) – The Division continues to expand and improve access to this searchable data-tracking system that keeps records of prescriptions filled in New Jersey for CDS. The information allows prescribers to make informed decisions about what is best for their patients by enabling them to spot patterns of prescription drug diversion or misuse by their patients, including “doctor shopping” to obtain CDS from multiple providers. Most recently, the Division expanded its interstate data-sharing capabilities to include New York, Delaware, Connecticut, Virginia, South Carolina, Rhode Island, and Minnesota.
* Expanding “Project Medicine Drop” to 215 Locations Across New Jersey – The Division developed Project Medicine Drop as an important component of its effort to halt the abuse and diversion of prescription drugs. It allows consumers to dispose of unused and expired medications anonymously, seven days a week, 365 days a year, at "prescription drug drop boxes" located within the headquarters of participating police departments. Since its launch in 2011, the Project Medicine Drop program has collected more than 78.5 tons of unwanted medicine and destroyed it safely through incineration.