In 2021, more than 80,000 people in the U.S. died from an opioid overdose. And opioids affect South Jersey residents disproportionally—Cumberland County ranks number two in New Jersey for opioid prescriptions and number four for drug deaths, according to the County Prosecutor’s Office.
When it comes to prescribing opioids to patients, providers should always consider the potential impact and ask themselves, “Does my patient need this large of a supply? Is there an alternative treatment or medication that I can recommend?”
Limits on Opioid Prescriptions
The New Jersey Department of Consumer Affairs (DCA) launched an initiative focused on stopping the abuse and diversion of prescription drugs. As part of this initiative, the New Jersey Prescription Monitoring Program (NJPMP) requires physicians to monitor patients’ habits, prescriptions, where they get them filled and how often.
The DCA has also set limits on prescribing opioids to certain populations. “The prescribing rules in New Jersey state that initial opioid prescriptions cannot be written for more than a 5-day supply, should be written for the lowest possible effective dose and should only include immediate-release medications until you know how the patient reacts,” said Joe Alessandrini, vice president of Clinical Services at Inspira. “The exception is patients undergoing treatment for cancer, chronic pain or palliative care.”
“Pain is a natural phenomenon,” said Alessandrini. “And you want to mitigate your patients’ pain. But there’s an opportunity to evaluate how you’re mitigating the pain. It’s important to think about alternative treatment options and even how many doses your patients may realistically use.”
What Inspira is Doing
As a high reliability organization (HRO), Inspira has been working on prescription abuse and diversion mitigation strategies for a number of years. “One of the ways we’re working to reduce harm is by purchasing and distributing Deterra drug deactivation kits,” said Alessandrini. “We were the first health network in the Delaware Valley to work with Deterra, which helps community members to safely dispose of unused medications.”
More recently, Inspira has reenergized our substance abuse prevention program and has partnered with law enforcement to devise new and improved strategies for mitigation. “We’re collaborating with the County Prosecutor’s Office, the Drug Enforcement Administration (DEA) and the Federal Bureau of Investigation (FBI) to establish metrics showing the impact on our community, as well as identify areas of opportunity for education,” said Alessandrini.
What Providers Can Do
The first thing providers can do to help reduce opioid abuse and diversion in South Jersey is to understand that we have the same issues as any big city. “This is a multi-regional effort bigger than Inspira,” said Alessandrini. “We’re seeing opioid abuse everywhere, and mitigating its effects will require everyone to work together—our medical staff, community partners, local government and more.”
It’s also important for providers to evaluate the way they’re prescribing opioids to their patients. Alessandrini shared an anecdote that demonstrates the value of thinking twice before prescribing a large number of doses.
“A few years ago I had major dental work that caused discomfort and pain, and my doctor wrote me a prescription for oxycodone. Initially, he wrote it for 30 tablets. I told him that was too many, and to write me a prescription for just five tablets and I would let him know how many I took when I returned in two weeks. That night, I took one tablet before bed to help me sleep, and I went back to him two weeks later with four tablets left in the bottle. If he had prescribed 30 tablets, I would have 29 unused tablets still in my home.”
Alessandrini’s experience serves as a reminder that patients don’t always need a large quantity of painkillers. By limiting the doses prescribed, the risk of “leftover” doses getting abused or diverted by children/grandchildren or visitors is reduced.
If you have questions about Inspira’s opioid stewardship, please contact Joe Alessandrini at alessandrinij@ihn.org.
