EDISON — Dr. Mark A. Vitale has been a local dentist for more than 30 years. He and other health care professionals are committed to prescribing less pain medication as a way to stem the opioid addiction epidemic.
During his residency program at JFK Medical Center, Vitale said he remembers a stamp that was ready made to prescribe the pain medication Vicodin. Rather than write out and sign a prescription, doctors and dentists could use a Vicodin stamp. And when he began his general practice in Edison in 1985, a Vicodin representative was on hand offering prescription samples.
“I think back now and question ‘What did we do?’,” he said.
On average, 3 out of 4 heroin users started their addiction with prescription opioids. The opioid epidemic is claiming an average of 175 American lives every day, according to health care officials.
New Jersey’s heroin overdose death rate is nearly triple the U.S. heroin overdose death rate. And on average, Naloxone, or Narcan, was administered 28 times a day by law enforcement and/or emergency medical services in New Jersey, in excess of 10,300 administrations in 2016.
Naloxone, or Narcan, is a medication designed to rapidly reverse opioid overdose.
A couple of years ago, Vitale, who serves as president of the New Jersey Dental Association, joined the Partnership for a Drug-Free New Jersey in its mission to “unsell” drugs to the people of New Jersey, especially the youth.
On Nov. 16, Vitale served as the moderator during the Partnership for the Drug-Free New Jersey’s Do No Harm: Safer Prescribing Symposium held at JFK Medical Center in Edison.
The Do No Harm symposiums started in 2013, and there have been more than 20 of them held since then. The one in Edison was the eighth one held in New Jersey this year.
The series has educated physicians and health systems to help them better understand the link between opioid prescription drug misuse and rising heroin abuse.
Vitale shared that substance abuse hit close to home when his sister, after a back surgery, became dependent on the pain killer Percocet, which led to an addiction to alcohol.
A similar situation involved his son-in-law. After suffering from chronic pain, Vitale said his son-in-law became dependent on Percocet, which led to an addiction to heroin.
Fortunately, Vitale said both of his loved ones have been clean for a year and a half.
The dentists and doctors at the symposium learned that the gateway leading toward an addiction to heroin, fentanyl and more recently carfentanil has “radically” shifted from the streets to local pharmacies, dentist and doctor offices.
That is why the fight to end the opioid epidemic needs many stakeholders from a law enforcement and legislation standpoint to the way a general dentist and doctor prescribes pain medication.
“We in law enforcement can’t do this alone,” said Timothy P. McMahon, a special agent with the Drug Enforcement Administration (DEA), New Jersey Division.
The symposium included remarks from Angelo M. Valente, executive director of the Partnership for a Drug-Free New Jersey, Andrew C. Carey, Middlesex County prosecutor, Ezra Helfand, executive director of Wellspring Center for Prevention, and Christopher Jakim, assistant special agent in charge with the DEA, New Jersey Division.
Carey said no one is immune to addiction.
“The drugs are cheap,” he said. “We cannot arrest our way out of [the opioid epidemic]. That is why there must be a partnership. It’s a law enforcement and health issue. We need to work together to aggressively target illegal drug trades that profit on violence and do not care that our citizens are dying. There needs to be education and treatment for those that need help.”
Carey said doctors and dentists can come to law enforcement on a volunteer basis.
“We’re not at a place to put blame on anybody,” he said.
Carey said some 456 tons — 912,305 pounds — of unused, unwanted prescription drugs were collected during the DEA’s 14th Prescription Drug Take Back Day at more than 5,300 collection sites across the United States.
The statistics of 456 tons collected was almost six tons more than what was collected at the spring prescription take back day, according to a press release by the DEA on Nov. 7.
The total amount of prescription drugs collected by DEA since the fall of 2010 is 9,015,668 pounds, or 4,508 tons.
Carey said the question that needs to be asked is “Why are there 456 tons of extra prescription drugs out there?”
“That needs to change quickly because [the use of] a small amount [of drugs] can be deadly,” he said.
Jakim, who has been a special agent with the DEA for 24 years, said it was a perfect storm that started brewing in 1996 with Mexican trafficking organizations forming, the pain revolution, which saw an increased use of opiate narcotics as a means of treating both chronic and acute pain, and extensive marketing by pharmaceutical companies for the pain medication.
During his career, Jakim has worked in New York, Philadelphia, as well as Cartagena, Colombia in South America where for three years he led teams of DEA special agents and Colombian drug law enforcement officers as they targeted, investigated and dismantled some of the most significant drug sources of supply in the world.
Jakim said one does not need a connection to a drug cartel in South America to get drugs.
There is what the DEA calls the “dark web” which six percent of the internet websites require specific software to access and are not indexed by WebCrawlers. Cryptocurrencies such as Bitcoin are used to help ensure anonymity.
“The dark web is fueling [the opioid crisis],” Jakim said, adding that another factor fueling the opioid crisis is the profitability of the drug trafficking market.
Jakim said fentanyl, an emerging threat, is more profitable than heroin due to fentanyl’s severe potency.
“A small amount goes a long way,” he said.
Heroin drug trafficking organizations can see approximately $70,000 in profit and the cost of pure fentanyl drug trafficking organizations can yield as much as $1.5 million.
“Fentanyl is 50 to 100 times more potent than morphine,” Jakim said.
He said the high potency of fentanyl increases risk of overdose and overdose deaths, users don’t know what they’re taking and there is an increase of fentanyl marketed as prescription opioids, which is infused in cocaine and methamphetamine.
Dr. A. Omar Abubaker, the chairman of the Department of Oral and Maxillofacial Surgery at Virginia Commonwealth University’s School of Dentistry and a national voice advocating for safer prescribing by dentists, and Dr. Sindy Paul, medical director of the New Jersey State Board of Medical Examiners, were also on hand at the symposium.
As a dentist and oral surgeon who has prescribed opioid painkillers throughout his career, Abubaker has a professional interest in the opioid epidemic and as a father, Abubaker came face to face with the opioid epidemic at home when he lost his 21-year-old son Adam to a heroin overdose in 2014.
“This is a story of many Americans, day in and day out,” Abubaker said. “You can’t even imagine the human impact beyond the numbers.”
Abubaker said his son at the time was 10 months into his recovery process and they were discussing a vacation to celebrate.
After his son’s death, Abubaker said, he started educating himself on addiction, earning a graduate certificate in international addiction studies. Since then, he has incorporated his knowledge on the topic to help change the way dental students and current dental professionals are taught about opioid prescribing.
The doctor said he is an optimist and believes with the partnership and needed policy changes, there will be an end to the opioid epidemic.
“Medical education, that is where change will have the most impact,” Abubaker said. “We should all be part of the solution.”
The seminar was co-sponsored by the New York/New Jersey High Intensity Drug Trafficking Areas program, the Drug Enforcement Administration – New Jersey Division, the Middlesex County Prosecutor’s Office, JFK Medical Center, the New Jersey Dental Association and Wellspring Center for Prevention.