Opioid addiction has reached such crisis levels that treatment experts are increasingly helping addicts fight their drug addiction with other drugs. It’s controversial, but it’s an idea being encouraged by the head of the New Jersey Reentry Corporation. Former Gov. Jim McGreevey recently talked about medication-assisted treatment with Correspondent Briana Vannozzi.
Vannozzi: So the New Jersey Reentry Corporation came out with a report in the fall, “A Modern Plague,” really detailing the horrors of this opioid crisis. But I wanted to talk about your work and look at this medication-assisted treatment. You have really been pushing for this. What is this about?
McGreevey: This is so important, and this is one of the most basic, fundamental tools we have at our disposal to battle overdose. And so whether it’s the New England Journal of Medicine, whether it’s the British journal, Nature, they’ve all indicated that medication-assisted treatment helps to enable the addict to survive these cravings. So you know, traditionally we’ve had methadone, which is an opiate replacement, and then Suboxone. We don’t actually use methadone with our clients, but Suboxone, and then there’s naltrexone or Vivitrol. What it is is, the neural lobes on the mind — the Vivitrol literally covers the neural lobes, so it blocks the ability of the neural receptors on your mind to attach to the opiate.
Vannozzi: So you can’t get high.
McGreevey: You can’t get high. And so for our clients, they come out of prison after 12 years, after two years, and some of the guys are literally dreaming about getting high. In the first two weeks after walking out of prison they are 129 times more likely to die than the average person. Why? Because their resistance to drugs have gone way down because they’ve been in prison, and they come out and they use their old dosage, but now it’s laced with fentanyl. And that’s why it’s so critically important that they have MAT. Because if they have this shot, either in prison or immediately upon release and their neural receptors are blocked, they are both cognizant of the fact — both psychologically and physiologically — that if they do two bags of dope, or three bags of dope, it doesn’t make a darn bit of difference. They’re not going to have that reaction.
Vannozzi: But the recommendation is not just to have the MAT, the medication-assisted treatment alone, correct? You’ll still be implementing therapies.
McGreevey: Exactly. So the challenge for us is, you know, we provide housing, legal, medical services, and wraparound services, and I think, God willing, we do all that well. But the real problem right now is, with 4,000 clients, and, you know, 3,000 people, more than 3,000 people died in New Jersey, for 2018. And the numbers in New Jersey are continuing to go up. The challenge is to provide for MAT, medication-assisted treatment, easily and readily. And so what happens is, whether it’s the doctor or the patient, today you have pre-authorization. And pre-authorization is a cumbersome process where you have to call the insurance company, or you have to call Medicaid, you have to secure prior approval. And the irony is if you’re giving Percocet, you’re giving oxycodone, you don’t need prior approval. But if you’re giving something that blocks the ability to get high from heroin or fentanyl, you have to go through this process, and this pre-authorization process is time-consuming. And it can take, you know, easily take two, three, four, five days. And so, instead of in other states, where the pre-authorization has been wiped out where somebody can immediately access Vivitrol.
Vannozzi: But there’s controversy about accessing that because, you know we’ve heard the argument, replacing one drug with another. Doesn’t it somewhat fly in the face of what we’ve come to know as the 12-step recovery process, where abstinence is really the first step?
McGreevey: I’m the biggest 12-step supporter, 12 steps are so critical. I mean, at the end of the day, after our clients move on, and re-entry isn’t there, it’s 12 steps, it’s NA, it’s AA — that’s the foundation, that’s the backbone of sobriety. But these drugs, I mean fentanyl, carfentanil, is 100 times stronger, so that these drugs are so powerful. And this is this is a synthetic opioid. This is literally fabricated in a laboratory. So we’re not talking about even the drugs that I knew in my past, in terms of when I was growing up, and the drugs that were available — these are synthetic opioids that are so powerful that literally change the neural passageways in the mind.
Vannozzi: Essentially making this a battle that really can’t be won.
McGreevey: Exactly. Thank you, you said that so much better than I could. But that’s it. It’s a battle that almost can’t be won by even the best of intentions, the greatest familial support, and I see our guys, I see our guys literally crying.
Vannozzi: Are you shifting focus to this because you’re seeing so much of it?
McGreevey: I know that, and I was the most conservative AA, NA. And by the way, I don’t think they’re at odds because particularly on the Vivitrol, it’s not an opiate, It’s a blocker. It has no street value whatsoever, unlike Suboxone. But when you look at the New England Journal of Medicine, which is arguably the premier academic research tool, and says, you know, “This saves lives.” And for doctors — for example, doctors who are addicts — nine out of 10 doctors who are addicts get cured, get sobriety in part through MAT. Whereas for clients that are coming out of prison, it’s one out of 10. I’ve seen literally the strongest guys begging for MAT because these cravings are so powerful, they’re like “Jim, I’m going to use. I’m going to use tonight if you don’t get me this MAT.” And so if people are willing to get sobriety, and all these academic journals and physicians say this is the right thing to do, well damn it, New Jersey, we have to do it, because these are our sons and daughters. And when over 3,000 people are dying, we need to do a lot better than this, and this is our battle.
Vannozzi: Let me ask you what needs to change, then, because there’s a federal cap on the number of doctors who are allowed to prescribe. But also, a New York Times report said that nationally 49 percent of the 3,000 residential programs — inpatient treatment programs — don’t use MAT. So do we need to see an across-the-board regulatory change for this to happen?
McGreevey: Yes. I think whether it’s — you know, and I’m so pleased with so many hospitals, and institutions, and Rutgers Behavioral Health who were trying to move in that direction — but we need to understand the importance. MAT has to be now almost a cornerstone aspect of treatment. And particularly, you know, I just pulled the toxicology reports in Jersey City, and there’s no more heroin in the heroin. It’s all fentanyl — there’s literally no heroin. It’s fentanyl that’s mixed. And so that if we have this, we need to understand that we’re not going to be able to achieve sobriety without medication-assisted treatment. So we have to bolster those numbers — whether that’s in drug court, whether that’s in residential treatment programs, intensive outpatient treatments — but we also need outpatient treatment. And that’s one of the concerns is that for our guys that are working, and paying off fees, and dealing with MVC and outstanding warrants, it’s really difficult today in the state of New Jersey to get Vivitrol unless you’re in an outpatient program, which can be, you know, six to 12 weeks, nine hours a day. What other states do is a simple outpatient program — you see the physician, you get the shot of Vivitrol, you come back next month and it becomes part of your cycle of life and treatment. What I think is important is to have outpatient access to MAT, to be able to see that physician not for two months or three months, but for a year to literally develop a longitudinal relationship with that physician for a year. The surgeon general says we need a year of treatment. And then also something called the Health Information Exchange. We need — and NJIT is looking at this — we need to track those persons that are in treatment programs — whether it’s residential, intensive outpatient or outpatient — track those people, so that the same way that you or I, if we were going into New Jersey or New York, tracking people for cancer cure or for heart disease — to track them to know what’s happened medically, to know what’s happened psychiatrically, to know what’s happened behavioral. Health information exchanges are so important.
Vannozzi: Thank you, Gov. Jim McGreevey, always a pleasure to have you on our set.
McGreevey: Thank you, thank you for caring about this because, again, lastly, this isn’t an academic question. People are dying tonight, and we need to provide MAT to help save those souls.