Newly Adopted Rule Requires Doctors to Co-Prescribe Naloxone to Patients at Risk of Overdose

NEWARK – As part of the State’s ongoing efforts to bring an end to New Jersey’s opioid epidemic and save lives, Attorney General Gurbir S. Grewal today announced four actions aimed at preventing fatal overdoses and further increasing the public availability of the opioid antidote naloxone.

The first action is a final rule recently adopted by the State Board of Medical Examiners (“BME”), which requires physicians who prescribe opioids for the management of chronic pain to also prescribe naloxone to certain patients who face heightened risk of a fatal overdose.

The three other actions are proposed rules that, if adopted, will impose similar co-prescribing requirements for prescribers licensed by the Board of Dentistry, the Board of Nursing, and the Board of Optometrists.

“By requiring the co-prescription of naloxone, we are ensuring that chronic pain patients and their families have ready access to a lifesaving antidote to reverse an opioid overdose,” said Attorney General Grewal. “The actions announced today are the latest examples of how New Jersey is wielding its regulatory authority as a powerful tool in the fight to end the opioid epidemic and save the lives of New Jersey residents.”

Under the final rule adopted by the BME in January, physicians must co-prescribe naloxone to any patient continuously receiving opioids for chronic pain management if the patient has one or more prescriptions totaling 90 morphine milligram equivalents (MME) or more per day, or is concurrently taking an opioid and a benzodiazepine. These patients face heightened risk of a fatal overdose. Those prescribing requirements would also apply to dentists, nurses, and optometrists upon the adoption of identical rules proposed by the boards that license those professionals.

Under both the final and proposed rules, prescribers do not need to co-prescribe an opioid antidote to a patient who is currently actively being treated for cancer, receiving hospice care from a licensed hospice, receiving palliative care, or residing in a long-term care facility. Additionally, prescribers do not need to co-prescribe an opioid antidote when prescribing medication for treatment of substance abuse or opioid dependence, and the requirement does not apply to medications being administered pursuant to medication orders in in-patient facilities.

The rules align with co-prescribing requirements temporarily in place under an Administrative Order issued by the Division of Consumer Affairs in May 2020 to address heighted concerns of fatal overdoses during the COVID-19 emergency.

“The new final rule and rule proposals we are announcing put in place a robust, clear regulatory infrastructure to guide the continued co-prescribing of naloxone to protect the health, safety and welfare of New Jerseyans,” said Kaitlin Caruso, Acting Director of the Division of Consumer Affairs. “The new rules will remain in effect even after the current health emergency ends, ensuring long-term, broad-based access to this life-saving prescription drug.”

“We are using all the tools at our disposal in our multi-pronged approach to combat the addiction crisis,” said Sharon M. Joyce, Director of the Office of the New Jersey Coordinator for Addiction Responses and Enforcement Strategies (“NJ CARES”). “The regulatory initiatives announced today support and advance that strategy.”

In addition to requiring the co-prescribing of naloxone, the regulatory actions amend existing rules to implement P.L. 2017, c. 341 to clarify the timing of the requirement to enter into a pain management agreement, amend the definition of “initial prescription,” and revise the definition of “chronic pain” in the rule consistent with the amended statute.

The notice of rule adoption for the BME can be viewed here.

The proposed rules on the following licensing boards, and information on how to submit a comment by March 20, 202, can be viewed by clicking the links below:

Board of Dentistry
Board of Nursing
Board of Optometrists

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The mission of the Division of Consumer Affairs, within the Department of Law and Public Safety, is to protect the public from fraud, deceit, misrepresentation and professional misconduct in the sale of goods and services in New Jersey through education, advocacy, regulation and enforcement. The Division pursues its mission through its 51 professional and occupational boards that oversee 720,000 licensees in the state, its Regulated Business section that oversees 60,000 NJ registered businesses, as well as its Office of Consumer Protection, Bureau of Securities, Charities Registration section, Office of Weights and Measures, and Legalized Games of Chance section.