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Albert Einstein, the great physicist, was once travelling from Princeton on a train when theconductor came down the aisle, punching the tickets of each passenger. Although Einsteinfeverishly searched, he could not find his ticket. Despite assurances from the conductor thateveryone knew who he was and a ticket was unnecessary, Dr. Einstein continued to search.The conductor said, "Dr. Einstein, Dr. Einstein, don’t worry. I know who you are. No problem.You don’t need a ticket. I’m sure you bought one." Einstein looked at him and said, "Youngman, I too know who I am. What I don’t know is where I’m going." Much like Dr. Einstein, New Jersey’s direction and policies regarding mental healthand substance use disorders, often appear rudderless and uncertain of theirintended destination. “We cannot arrest our way out of this problem” has becomeone of the most oft used phrases by elected leaders, law enforcement, healthprofessionals, and even people with lived experience when discussing theappropriate response to the mental health and substance use disorder crises weare facing. What New Jersey, and America’s stakeholders cannot seem to agreeupon, is what will help to get ourselves “out of this problem.” In the absence of aclear solution and direction, there is a void that is too often filled with a plethoraof accepted exceptions to the “no arresting our way out of this problem” talkingpoint, all with purported rationalizations for the same. These policies areexacerbating the crises we are in, and while perhaps well intentioned, arecontributing to the deaths and harm from substance use disorders. Summer Newsletter 2023Is This Now?Page 1Author: Nikki Tierney

Nowhere is this uncertainty of acoherent pathway to our destinationmore evident than in some of therecent actions by the New Jerseylegislature. New Jersey has made someastounding strides in eliminatingbarriers and increasing access totreatment and harm reductionsupplies, investing in education andprevention programs, with regard tosuicide, mental health and substanceuse disorders, and embracing the harmcaused by responding to behavioralhealth issues with criminal or punitiveresponses. However, New Jersey hasalso taken several steps backwards andsideways in responding to the presentmental health and substance usedisorder crises by falling for the allureof punishment and retribution. Thisdespite 50 years of proof, a la thefailed “War on Drugs,” that punishmentdoes not work to change behaviorsassociated with mental health andsubstance use disorders.Page 2There is a consensus amongstmultidisciplinary professionals thatsubstance use changes a person’sbrain. Drugs impact the way neuronssend, receive, and process signals vianeurotransmitters, overstimulates thebrain’s “reward circuit,” and diminishesthe functioning of the prefrontalcortex.[1] All of these changes combineto “make a person with a substance usedisorder seek the drug compulsivelywith reduced impulse control.”[2]Consequently, scientists, mental healthprofessionals, criminologists,physicians, data, and thousands ofstudies reveal that punishment andpunitive responses are directly at oddswith the dominant definition ofsubstance use as a public healthproblem and also at odds withevidence-based public healthresponses to preventing substance-userelated harms.[3] Stated otherwise,punitive responses do not work tochange behavior. Such draconianresponses are ineffective and cruel.Despite this knowledge, the New JerseyLegislature is taking some alarmingactions as the severity of the substanceuse disorder epidemic is worsening.

Page 3 For example, the New Jersey Senatepassed S3325, which enhances thepenalties for distribution andmanufacture of certain amounts offentanyl, 32 to 0. Admittedly, thislegislation still needs to be passed in theGeneral Assembly and signed by theGovernor before becoming law, but thevote of 32 to 0 speaks volumes on theauthenticity of our commitment not to“arrest our way out of this problem.” Thebill was justified as not intending totarget people with substance usedisorders, but only ‘high-level drugdealers.’ While that premise is highlyquestionable, even assuming arguendo itwas true, supply side interdiction alonewill not produce any real decreases in theamount of deaths and damage from thecurrent substance use disorder crisis. Infact, the supply shock that resulted afterthe implementation of the prescriptiondrug monitoring program actuallycontributed to the current epidemic.Supply shock decrease without adequatetreatment led to higher rates of suicideand more importantly to migration toover-accessible substitute drugs such asfentanyl and heroin.[1] Thus even if thislaw would only lead to the incarcerationof ‘high-level drug dealers’ and decreasethe supply of fentanyl analogues, it stillwill not decrease deaths or harm fromsubstance use disorders. Even if effective in its statedpurpose, this bill is ineffective.In a similar fashion, the legislature hasintroduced S2155/A2119 which addsillicit fentanyl to Schedule I in the"New Jersey Controlled DangerousSubstances Act;" A5488 whichclassifies xylazine as a Schedule IIIcontrolled dangerous substance undercertain circumstances and requiresreporting of xylazine prescriptions;and S3973, introduced as recently asJune 15, 2023, reinstates the penaltyfor underage possession andconsumption of alcohol and cannabisas a disorderly person offense. Thislast law not only advocates forpunishment, but punishment ofjuveniles whose brains are not fullydeveloped. Again, these proposed billswill have absolutely no net effect onthe negative impacts our state issuffering from substance usedisorders. These proposed lawsthreaten the recent progress NewJersey has made in its commitment to“not arresting our way out of thisproblem.”

Page 4Conversely, since NCAAR’s lastnewsletter, the New JerseyLegislature has taken bold action toincrease education, awareness, andprevention related to suicide oncollege campuses, in response tothe recent alarming increase insuch preventable deaths. Morespecifically, A1176 (AcaSca) andS5 0 3 require institutions of highereducation to implement suicideprevention programs and raiseawareness of mental healthservices. These bills amend theMadison Holleran SuicidePrevention Act to require mentalhealth experts on campus to workwith and annually train faculty andresident assistants to recognizesigns of depression, as well aswarning signs and risk factors ofsuicide. This law would also requiretraining on referring students tocrisis hotlines and mental healthscreenings. The bill passed in theSenate 36 to 0 and the Assembly 77to 0 and is awaiting the Governor’ssignature. Similarly, in order toincrease access to treatment forpeople who are particularlyvulnerable, on May 15, 2023,Governor Murphy signedA4 7 5 5 /S3 2 6 1 into law, whichpermits behavioral and mentalhealth care providers to operatewithin homeless shelters. A 475 5passed in the Assembly 74 to 0 andin the Senate 36 to 0. This legislation will improve thequality of life for so many byproviding access to evidence-based treatment for behavioralhealth disorders. Both of theselaws will reduce the harms peoplesuffer from mental health andsubstance use disorders. Next, New Jersey is also the firststate in the nation to legislativelyrequire the use of medicallycorrect and non-stigmatizingterminology in its statutes andgovernment entity names relatedto substance use disorder. In itslast session before summer breakon June 30, 2023, the Senatevoted in favor of S 3 511 , 37 t o 0and the Assembly approved itsversion, A50 9 6 , 76 to 2, whichboth respectively remove allstigmatizing language from itsstatutes and government names.As with the suicide legislation,and legislation to allow treatmentin homeless shelters, there wasalmost complete agreement by alllegislators, from all parties,representing consultants of allparts of New Jersey thatdisrespect, dehumanization, andpunishment will not help thehistorical challenge we are facingwith regard to mental health andsubstance use disorders.

In fact, the challenge we are facing isso unprecedented that a recent studypublished in the Journal of theAmerican Medical Associationrevealed that deaths from fatal drugpoisonings and gun violence havesoared since the beginning of thepandemic and consequently, lifeexpectancy in America is consistentlydecreasing for the first time indecades.[1] Between 2019 and 2020,the United States experienced arecord-high 30% increase in deathsfrom drugs, primarily as a result offentanyl analogues.[2] Tragically, wehave also seen the sharpest increasein child mortality in 50 years, due todrugs and gun violence.[3] Whilethese may be statistics, theyrepresent human lives, the loss ofwhich are a culmination of failedpolicies and responses that, again,New Jersey seems to be reverting to,despite the fatal danger of doing so. Page 5Not only is New Jersey’sregression evident in theincrease of attempts tocriminalize substance use andpunish people with substanceuse disorders, but also in thefact that legislation thatincludes evidence-basedresponses over punishment arereceived with fervent oppositionand extremely harmful rhetoric.More specifically A 1 7 00/ S 5 2 4creates a Mental HealthDiversion Program to diverteligible persons away from thecriminal justice system and intoappropriate case managementand mental health services.While it is headed to theGovernor’s desk, there was lessthan consensus amongst ourlegislators. The Senate versionpassed by a mere 6 votes, 21-15,and the Assembly version passed45 - 28-2.

Not only was the number oflegislators opposed to the billtroubling, but so was the nature ofthe opposition. Senator Steinhardt,who opposed the bill stated “[u]nderthe Democrats’ bill, an offenderwould be able to hire a social workerto say they experienced depression,and that could be enough to getthem into the diversion program. Anycriminal who actually ends up in jailunder this law would have to be acomplete idiot.” This statementattacks the professionalism andethics of mental health professionalsand uses such stigmatizing words like“offender”, “criminal”, and “idiot” inreference to people with mentalhealth disorders. Not only can we“not arrest our way out of thisproblem,” but we cannot “insult” ourway out of it either. Notably, actingEssex County Prosecutor TedStephens testified, “It has been anoverwhelming success. In the 12years we’ve been running theprogram — approximately at 30 or soindividuals every year — only twoindividuals in our record have everhad any recidivism.” The cognitivedistortion, bias, stigma, andignorance demonstrated in theopposition to this bill seeminglyreveals that while the New JerseyLegislature may be known as theState who protests that “we cannotarrest our way out of this problem,”we do not know our final destinationor how to get there. Page 6 New Jersey has led the nationin enacting some evidence-based legislation that willunquestionably save lives andreduce the harm endured bypeople in our state with mentalhealth and substance usedisorders. At no time has thisdirection been more necessaryas the current epidemic is theworst it has ever been and withthe recent frequency ofxylazine in our drug supply, itwill likely only worsen. NewJersey must adopt policies thatare effective, humane, andconsistent with the principlesthat make our State a leader inthe nation in terms of access tofree naloxone, removing stigma,and implementing evidence-based principles of harmreduction. The ‘cost’ ofstraying from our destinationwill impose the worstpunishment of all, in terms oflives damaged and lives lost.

Page 7Footnotes 1] Drugs, Brains, and Behavior: The Science of Addiction.https://nida.nih.gov/publications/drugs-brains-behavior-science-addiction/drugs-brain[2] See id. [3] Carroll, J., El-Sabawi T. & Ostrach, B. The harms of punishing substanceuse during pregnancy. International Journal of Drug Policy, Volume 98, 2021,103433, https://doi.org/10.1016/j.drugpo.2021.103433. [1] Woolf SH, Schoomaker H. Life Expectancy and Mortality Rates in the UnitedStates, 1959-2017. JAMA. 2019;322(20):1996–2016.doi:10.1001/jama.2019.16932[2] See id. [3] See id.