Salvador Rizzo

The (Bergen County, N.J.) Record

TRENTON, N.J. — New Jersey Attorney General Chris Porrino is using emergency powers to impose some of the toughest restrictions in the United States on painkiller prescriptions, part of an aggressive campaign against drug addiction outlined by Gov. Chris Christie that could also include an investigation into relationships between doctors and drug manufacturers.

In a letter to the Board of Medical Examiners last week, Porrino cited his emergency powers and said he would amend several state regulations on the practice of medicine to prevent "the tragic consequences of the prescription opioid and heroin epidemic."

The key change would be to cut doctors' ability to prescribe 30 days' worth of opioid painkillers — such as Percocet, OxyContin, Vicodin and generic alternatives — down to five days' worth for cases of acute pain.

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When treating chronic pain, the amendments would call for "pain management contracts, periodic urine screens and referrals to specialists."

"Provisions requiring discussions with patients concerning the risks, benefits and alternatives to opioid prescribing would also be incorporated," Porrino wrote, asking the Board of Medical Examiners to support his proposals before Feb. 16.

Because the rule changes are being made under the state's emergency powers, they would take effect as soon as they are filed with the Office of Administrative Law, Porrino wrote. He added he would submit a "concurrent proposal," which would allow members of the public and the medical community to submit comments.

In his State of the State speech this month that focused largely on the opioid addiction problem in New Jersey, Christie noted that drug deaths spiked in 2015 and said "lives are derailed and turned upside down by the careless abundance of opioids in our state."

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The success of the effort by Christie — who had opposed health care mandates when he first ran for governor but now finds himself in a fight against the medical community and New Jersey's large drug manufacturing industry — is riding largely on Porrino, a former criminal defense lawyer and chief counsel to the governor who became attorney general last year.

The Medical Society of New Jersey criticized the regulatory change after Christie's speech, saying such limits "decrease the quality of care and life for pain patients."

"The Medical Society of New Jersey opposes such intrusions into the practice of medicine, especially if they do not take into account individual patient circumstances, like medication tolerance or access to insurance, transportation or alternative treatments," the society said. "This is especially cruel given that over 70 percent of abuse comes from diversion not from patient misuse."

In one of the most pointed remarks in his speech, Christie said Porrino "if necessary … should open an investigation of the prescribing practices of our medical community and their interaction with the industry manufacturing these drugs."

"Profit, by physicians or the pharmaceutical industry, must never be a rationale for contributing to the death of our citizens by overprescribing of these drugs,” Christie said.

Asked about Christie's remarks, Porrino said in a brief interview: "I heard what he said and there are a number of facts out there that are concerning, and we take them very, very seriously. I can't tell you whether we have an ongoing investigation or we don't, but we take this issue very, very seriously and it's one that … is not getting better."

Several states have passed laws imposing a seven-day limit on opioid painkiller prescriptions, including Connecticut, Maine, Massachusetts and New York. Porrino said New Jersey would be the first to reduce the window to five days. The new rules he is proposing would allow doctors to prescribe more painkillers after a direct consultation in person or by phone.

"You could be under the care of a doctor and become addicted," Porrino told a group of several hundred students in Fort Lee High School on Friday, where he was a freshman in 1981. Citing figures from the American Society of Addiction Medicine, he said "four out of five heroin addicts that are walking the streets became addicted through prescription opioids."

Some of his classmates who became addicted to prescription painkillers or heroin died or lost their families or jobs, Porrino said. "It's not a great picture," he said.

"If the doctor is going to prescribe you painkillers, ask them, 'Is it addictive? And what alternatives are there?'" he told the students.

New Jersey recorded 1,306 drug deaths in 2014 and 1,587 in 2015, an increase of 21%. Christie said in his speech the figure represented four times the number of homicides and three times the number of car-accident deaths.

Statewide statistics for 2016 are not yet available. Bergen County Prosecutor Gurbir Grewal said there were 90 drug deaths in the county last year, a number that would have been higher if not for the emergency use of Narcan, an antidote to opiates.

Bergen County officials administered Narcan 180 times last year, Grewal said. So far this year, five people in the county have died from drug overdose, he added.

"No pocket in this county is safe from it. It’s affecting rich and poor, young and old, male and female, educated and uneducated," he said. "Not a day goes by where we don’t have a heroin arrest, a heroin overdose, a Narcan save, or a heroin fatality."

Follow Salvador Rizzo on Twitter: @rizzoTK