What You Need To Know
The New Jersey Department of Health (NJDOH) has been informed of an Atlantic County-based clinician prescribing controlled dangerous substances (CDS) who surrendered their Drug Enforcement Administration (DEA) license, making this clinician unable to continue prescribing such medications. Patients receiving care from this provider were receiving prescriptions for medications, including benzodiazepines and stimulants. This incident has led to a disruption in access to care and patient medical records for approximately 250-300 patients, leaving patients at risk for withdrawal symptoms due to an abrupt discontinuation of benzodiazepines and more vulnerable to an overdose if they turn to the illicit drug supply. Abrupt withdrawal from benzodiazepines can be life-threatening. This health alert is being issued to alert providers to the potential health concerns of impacted Patients.
What are Benzodiazepines?
Benzodiazepines are Schedule IV classified depressants that produce sedation and hypnosis, relieve anxiety and muscle spasms, and can also reduce seizures. Common brand-named Benzodiazepines include Valium (diazepam), Xanax (alprazolam), Ativan (lorazepam), and Klonopin (clonazepam). Tolerance and dependency to benzodiazepines can develop with frequent use.
Benzodiazepine Withdrawal Health and Safety Risks
Abrupt discontinuation of benzodiazepines can lead to withdrawal symptoms, which can be mild, severe, or life-threatening. Symptoms of benzodiazepine withdrawal include:
- Anxiety
- Tremors
- Irritability
- Insomnia
- Nausea/Vomiting
- Heart Palpitations
- Seizures
- Hallucinations
- Death
The onset of withdrawal symptoms associated with benzodiazepine discontinuation can vary based on the half-life of the medication prescribed and the dosage taken. It is important to note that patients who lose access to their medications and are unable to access care may try to obtain benzodiazepines from an illicit source. With high rates of counterfeit pills containing fentanyl, these individuals are at an increased risk for overdose or death.
What are Stimulants?
Stimulants are a class of substances that speed up the body’s systems. This class of drugs includes prescription medications such as amphetamines (e.g., Adderall and Dexedrine), methylphenidate (e.g., Concerta® and Ritalin), diet aids such as Didrex, and other illicitly used drugs such as methamphetamine and cocaine.
Stimulant Safety Risks
Stimulants can produce exhilaration, extended wakefulness, and loss of appetite. These effects are intensified when taken in large doses. Taking too large a dose at one time or over an extended period of time may cause side effects such as dizziness, tremors, headache, flushed skin, chest pain with palpitations, excessive sweating, vomiting, and abdominal cramps.
Recommendations for Health Care Providers
It is critical that patients who are prescribed CDS who lose access to their prescribing provider are re-connected to healthcare services as quickly as possible. Patients with a primary care provider should be encouraged to contact them immediately to discuss next steps in care. If the patient does not have a primary care provider, they should be encouraged to call the number on the back of their insurance card to receive help in finding an in-network provider to continue receiving care. Patients without health insurance coverage can be seen at a community health center by visiting findahealthcenter.hrsa.gov.
Providers are also encouraged to:
- Counsel patients on the risks of abrupt discontinuation of benzodiazepines and withdrawal symptoms.
- Provide person-centered, non-judgmental, and trauma-informed care to patients.
- Educate patients about counterfeit pills in the illicit drug supply and the dangers of fentanyl. Remind patients that any pill that was not directly obtained from a pharmacy may contain fentanyl, which increases the risk of a fatal overdose. This includes pressed stimulants and benzodiazepine pills. Patients who are naïve to fentanyl (e.g., those obtaining controlled substances from a regulated source) are at an extremely high risk of overdose if exposed to fentanyl.
- Carry naloxone (Narcan) and encourage its use when a person’s respiration is depressed or if an opioid overdose is suspected.
- Provide information about harm reduction and safer use tips, including the use of fentanyl test strips, trying a different route of administration, carrying naloxone, and going slow/using less with a new substance.
- Refer individuals to local harm reduction agencies or other trusted, community-based providers available to connect patients to needed resources (i.e., sterile syringes, overdose education, HIV testing, fentanyl test strips, etc.). For more information on New Jersey’s Harm Reduction Centers, visit https://www.nj.gov/health/hivstdtb/hrc/.
Where to get Naloxone (Narcan)
- NJ residents can obtain naloxone freely and anonymously at participating pharmacies. Information and locations are available https://nj.gov/humanservices/stopoverdoses/.
- In addition to local harm reduction centers, the New Jersey Harm Reduction Coalition mails naloxone kits confidentially and for free to anyone who needs them, regardless of insurance status. You can call or text 1-877-4NARCAN or visit www.nextdistro.org/newjersey.
Treatment and Support
- ReachNJ is a 24-hour-a-day, 7-day-a-week hotline where people who have substance use disorder (SUD) or friends and family of people with SUD can get immediate assistance and support from live, New Jersey-based, trained addiction counselors. Call 1-844-ReachNJ (1- 844-732-2465).
- 988 is the nationwide 3-digit dialing code for Mental Health Crisis and Suicide Prevention. 988 will connect people to the existing National Suicide Prevention Lifeline. Compassionate, accessible care and support will be available for anyone experiencing mental health-related distress, thoughts of suicide, mental health or substance use crisis. People can also dial 988 if they are worried about a loved one who may need crisis support.
For more information, please contact Amanda Gan at the New Jersey Department of Health at Amanda.Gan@doh.nj.gov.