Rutgers forum centers
On early intervention
New Jersey’s opiate crisis has spurred numerous measures and discussions examining addiction and overdoses that arise from misuse of prescription pain medicine or heroin. Less focus on a statewide level has been on keeping people, especially youth, from reaching the point at which drugs have taken over their lives, or even taken their lives. That was not the case at a June 1 legislative forum at the Rutgers University School of Nursing, at which one model of early intervention holds promise to identify and help youth who are just on the cusp of drug misuse.
The forum’s co-hosts were Sen. Joseph Vitale (D-Middlesex) and NJ Citizen Action. Moderating the event was Joel Cantor, director of the Center for State Health Policy at Rutgers University.
NJCA’s Maura Collinsgru noted that while there have been many forums around the state to examine the severe opiate problem, this one differed in two important ways: The emphasis was on youth and it introduced an evidence-based model that has seen success with adults. That evidence-based model is Screening, Brief Intervention, and Referral to Treatment, SBIRT for short.
Late last year, Vitale took part in a learning trip on the SBIRT model in Massachusetts, which recently passed a bill to use it in all schools (105 schools will begin using it in the fall). So impressed was the Senator that he is sponsoring a similar bill to be introduced in New Jersey, likely in the fall. The need for early intervention is abundantly clear. New Jersey’s youth overdose rate is sixth nationally.
Melissa Ough, policy analyst with Massachusetts-based Community Catalyst, reviewed her home state’s program as well as Wisconsin’s. She said across the country there has been a shift in opiate prescribing practices and an expanded use of the overdose reversal drug naloxone. What has been lacking, she said, is early intervention.
She noted that New Jersey has been a leader in using SBIRT with adults, so it follows that it would be broadened to cover youth, who are being so affected by the opiate crisis. Ough took a question about confidentiality and legal repercussions. The Massachusetts law ensures that students would not face any legal or academic consequences if they confide drug use on the questionnaire. New Jersey’s proposal has similar protections.
Giving a clinical perspective was Michelle Eichorn of Trinitas Medical Center. She spoke of making systems change with respect to drug use, meaning that addiction or problem use are treated as any other health issue. The goal, she said, is to remove the stigma that for so long kept people from seeking treatment. Stigma has also played a large role in limiting treatment capacity.
Eichorn contrasted the percent of patients at Trinitas seeking treatment before SBIRT with what has occurred since its implementation. Prior to the program there, which questions every patient about drug use, 1-2 percent sought treatment. With the advent of SBIRT at the hospital, anywhere from 6-15 percent express interest in drug or alcohol treatment. That early intervention, she said, translates into enormous cost savings compared with having to treat someone who has had years of drug use.
Mariel Harrison of Young People in Recovery recalled her addiction and how her life, her family’s life and her community would have been different had she been asked about drug use at an early age. Multiple times during her talk she said she needed to confide the depth of her sadness. “I was dying to say I was dying,” she said. Now 30, Harrison has been in recovery since she was 21.
“SBIRT,” Harrison said, “is prevention in action.” She contrasted it with ineffective programs such as DARE, which has been in schools for decades without reducing drug use in the least.
While it seems there is every reason to implement SBIRT, there are some concerns about how and who would administer it and what resources would be needed. The screening is a series of questions that students would answer about their drug use, which would be given to them by the school nurse, a student assistance coordinator or other trained professional.
Assemblywoman Nancy Munoz (R-Essex, Union), one of two members of the Assembly who attended the forum, raised the issue of how much time school personnel would be expected to devote to giving and reviewing the questionnaires and then following up with students whose answers indicated a potential problem. She said this could amount to an unfunded mandate imposed on localities by the state, which would be a sticking point.
In spite of that challenge outlined by Munoz, most of the advocates felt the state and school districts could find a way to implement the SBIRT model, possibly sharing the fiscal impact. The severity of the opiate crisis in New Jersey, supporters said, would be motivation to find a way.
Vitale closed out the evening by talking about the package of bills he and other lawmakers crafted to address the opiate problem. He said it was a deliberative process that eventually produced four prongs of attack: prevention, education, treatment and recovery. As for prevention, he said it needed to be evidence-based.
The senator spoke of the state’s front-end (prevention) and back-end (life-saving) approaches to the widespread misuse of heroin and prescription opiates. On the back end, he cited the increased use of Narcan, a drug that reverses the effects of an overdose. But that, he said, illustrates how many lives needed saving with Narcan. “The good news is we have seen 11,000 overdose reversals; the bad news is we have seen 11,000 overdose reversals,” he said, citing recent statistics.
Adopting SBIRT on a statewide basis to catch drug use early on, the senator stressed, would keep many from becoming addicted and reaching the point of needing emergency measures to save their lives.
