In 2017, New Jersey passed sweeping and landmark legislation to combat the opioid crisis. Now, a new series of reports by the Rutgers Center for State Health Policy shows the legislation and the state’s ongoing efforts have contributed to significant reductions in opioid prescribing and increases in access to treatment.
The new reports detail analyses conducted over the last 18 months as part of a project funded by the Horizon Foundation for New Jersey to evaluate the 2017 legislation. Among other measures, the law established a five-day limitation on new opioid prescriptions for acute pain aimed at reducing overprescribing, and loosened restrictions to remove barriers to evidence-based medication assisted treatment, also known as MAT.
In the years before the law was enacted, opioid deaths increased more than 66% in New Jersey, from 1,336 deaths in 2013 to 2,221 deaths in 2016.
“The opioid crisis has threatened to reverse more than 70 years of progress in extending life expectancy. This legislation and the state’s efforts since illustrate New Jersey’s continued commitment to fighting substance use and behavioral health challenges, and this important set of reports highlights significant progress that has been made,” said Stephen Crystal, senior investigator on the project and the director of the Rutgers Center for Health Services Research. Both centers are within the Rutgers Institute for Health, Health Care Policy and Aging Research.
“With these challenges becoming even more difficult as the effects of the COVID-19 epidemic intersect with those of the opioid epidemic, the dedicated work that is being done by state leadership and those on the front lines of treatment to help people with substance use disorders on their difficult road to recovery becomes even more critical,” Crystal said.
Researchers compared publicly available outpatient Medicaid data from the years prior to the legislation to the second part of 2018 and saw opioid prescriptions and associated reimbursement costs nearly cut in half. The researchers estimated the changes potentially saved the state’s Medicaid program nearly $8.6 million in prescription costs for the last quarter of 2018.
Over the same time period, the researchers saw increases in prescriptions and Medicaid spending for some forms of MAT — most notably for naltrexone, commonly known by the brand name Vivitrol, which more than doubled.
Researchers also conducted in-depth interviews with New Jersey doctors and advanced practice nurses who accept Medicaid to assess how the legislation had affected their prescribing practices and patients.
“A qualitative analysis like this lets prescribers tell us what they are thinking and gets at some of the whys behind the data. They are both important to understanding the overall impact,” said Jennifer Farnham, lead author of the qualitative report and senior research analyst at the Center for State Health Policy.
Most prescribers agreed with the limitations on opioid prescriptions, the researchers found, and many already had used similar measures before the law was enacted. There was less agreement, however, when it came to questions related to long-term prescribing of opioids for chronic pain, unintended consequences of limitations such as untreated pain, and whether to begin providing MAT for patients with addiction.
The new reports are available on the center’s website at www.cshp.rutgers.edu/publications.