Opioid Overdose in New Jersey: Trends and Needed Interventions

When we last reported on the opioid crisis in New Jersey in our article Substance Abuse and Addiction: The Situation in New Jersey by Christopher White, our New Jersey Regional Director, the biggest problem in the state was heroin. At that time, almost half of admissions to drug treatment programs in the state were for heroin addiction.

At that time, heroin addiction was associated with a disproportionate number of prescriptions for opioid painkillers. We highlighted data from the Centers for Disease Control (CDC), which indicated that in 2017, providers wrote opioid prescriptions at a rate of 44.2 for every 100 residents of New Jersey.

In that same article, we shared reports from the Drug Enforcement Agency (DEA) about a wave of illicit fentanyl – a drug 50 to a hundred times more potent than morphine – reaching New Jersey. Along with heroin and cocaine, drug traffickers regularly shipped large amounts of illicit fentanyl to New Jersey. Its proximity to major urban centers, and accessibility by sea, air, and land made New Jersey an ideal staging point for the illegal drug trade. Dealers used fentanyl to “cut” heroin, cocaine, and methamphetamine, which increased overdose risk for people with substance use disorder.

People with opioid use disorder (OUD) were at particular risk of overdose at the time – and they still are. New reports from the DEA indicate that in 2021, law enforcement seized enough fentanyl in 2021 to “provide a lethal does to every American.”

This article will give a brief report on two new studies published about the opioid situation in New Jersey since we published our initial article: one examined the trends in overdose in New Jersey between 2014 and 2019, while the other examined the locations where overdoses took place. Both these studies help us calibrate our addiction treatment efforts in New Jersey.

Overdose In New Jersey: How Often, and Where?

The first study looked at overdose rates over a five-year period. The period researchers examined is critical, because it included two years of data from before the opioid crisis got the attention of the nation, and also examined data from two years after the implementation of a nationwide prescription drug monitoring program, which was designed to rein in the excessive prescription rates we describe above. This overview can give us clues about the effectiveness of efforts to reduce opioid addiction, opioid overdose, and death.

Here’s what they found:

• In New Jersey, overdose risk tripled from 2014-2019:
  • 2014: 120.5 per 100,000 person-years*
  • 2019: 426.5 per 100,000 person-years

* A person-year is a statistical measurement that takes into account the number of people in a study and how long they’re studied. If a study follows 10 people for one year, it then has 10 person-years of data.*

• Increases were related to:
  • Heroin
  • Synthetic opioids, i.e. fentanyl
• Researchers observed the most increased risk in people with:
  • Alcohol use disorder (AUD)
  • Other substance use disorders (SUDs)
  • Major depressive disorder (MDD)
• Increases were also related to increased presence of fentanyl in New Jersey.
  • Heroin seizure by law enforcement that included fentanyl, 2014: 2%
  • Heroin seizure by law enforcement that included fentanyl, 2019: 80%
• Reduction in opioid prescriptions did not impact overdose risk:
  • Percentage of Medicaid beneficiaries with opioid prescriptions 2014: 23%
  • Percentage of Medicaid beneficiaries with opioid prescriptions 2019: 13%

Those statistics confirm the DEA warnings about fentanyl, and show us that when we direct our addiction treatment efforts to New Jersey, we’re targeting a place where there’s clearly a demonstrated need for increased support for people with OUD, SUD, and AUD.

Now let’s look at that second study about the location of overdoses in New Jersey. Researchers collected data from 3,970 people who survived overdose during the pandemic. Here’s what they found about where people overdosed:

• Private residences: 65%
• Outdoor, public: 15%
• Indoor, public: 9%
• In vehicles: 8%

Taken together, the data from these studies help inform us which citizens in New Jersey are at greatest risk and in greatest need, where we should focus our attention, and the appropriate tools to use to help prevent addiction and overdose in New Jersey.

Opioid Addiction Treatment in New Jersey: What Interventions Can Help?

When we look at the first study, here’s what we learn:

1. Fentanyl increased overdose risk for many categories of addiction, not just opioids
2. People with SUD and a mental health disorders – called co-occurring disorders – are at increased risk of overdose
3. Intervention-wise, we need to increase access to and prioritize the counseling, therapy, and psychiatric components of addiction treatment. This means:
   1. Increase screening for all substance use after overdose
   2. Increase screening for mental health disorders for all people in treatment, and specifically after an overdose event

Here’s what we learn when we consider the data in the second study:

• During COVID-19, most overdoses happened to people at home
• The second most common place was in public, outdoors
• Outdoor overdose was more common in high population density, low-income urban areas
• Intervention-wise, we need to increase the distribution of the overdose-reversing drug, Narcan, targeting:
  • Families of people with OUD or SUD, to reverse overdose in private residences
  • First responders, law enforcement, and community members in high-risk, low-income urban areas

We see these studies as both a warning and as a guide: we were confident reducing prescription rates would reduce overdose rates – but the influx of fentanyl complicated the situation by increasing overdose risk across several types of drug use, in addition to heroin and other opioids. We can adapt to that, and know how to help: increase support and treatment access across New Jersey. This is the same thing we need to do for people with co-occurring SUD and mental health disorders, with a slightly different approach: we need to enhance psychiatric screening and support for people with any type of substance use disorder, including people with alcohol and methamphetamine addiction. Finally, the data in the second study tells us that the more Narcan – the lifesaving overdose reversal drugs – we can get into high-risk areas, the more lives we can save.

Believe us: we take this data to heart.

We have our attention on the at-risk citizen of New Jersey – and we’re to help them find a path to recovery in any way we can.

Learn more about our opioid and substance use disorder treatment centers in New Jersey.

By Anton Kemps, MD, Medical Doctor, Delaware Valley Medical in New Jersey