The heroin and opioid epidemic in New Jersey and throughout the nation has been spiraling out of control, with the death toll from drug overdoses rising each year and the demand for treatment overwhelming the facilities and resources needed to meet the demand. What is being done to address the problem and what more should be done to start turning the tide? We turned to Debra Wentz, president and CEO of the New Jersey Association of Mental Health and Addiction Agencies, for some answers.

Can you provide us with a 30,000-foot view of the extent and severity of the heroin/opioid problem in New Jersey?

The heroin/opioid epidemic is one of the most critical problems facing our state. It is a huge health problem, claiming and threatening lives in every demographic group.

According to a report published by Trust for America’s Health, New Jersey had the 11th-lowest drug overdose fatality rate in the United States in 2013. At that time, New Jersey’s rate was 9.8 per 100,000 people.

However, New Jersey’s heroin overdose death rate is now more than three times the national average and has more than tripled since 2010, according to the Centers for Disease Control and Prevention. This rate increased in four consecutive years (2011 through 2014), reaching a total 155 percent increase since 2010. Four counties — Middlesex, Monmouth, Bergen and Passaic —showed increases of 25 percent or more in just one year, from 2013 to 2014.

According to the New Jersey Division of Mental Health and Addiction Services (DMHAS), heroin and other opioids combined resulted in 49 percent of substance use treatment admissions in 2014.

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Give us a thumbnail demographic profile of the opioid addict. How does the profile of heroin addicts differ from that of those addicted to prescription drugs? At what age does heroin addiction typically begin? And how? Peer pressure?

There is no real profile, as opioid addictions can develop in anyone: young, old, in affluent neighborhoods and inner cities, and in all ethnic populations.

Similarly, addiction to heroin can occur in all demographic groups. This commonly happens after addiction to opioids develops and there is no more access to the prescribed medications. In fact, heroin use is 40 times more likely among those who develop addiction to prescription opioids. Among teens and young adults, this could occur, for example, if they are prescribed opiates to manage the pain from sports injuries or removal of wisdom teeth.

Any drug use — actually any kind of risky behavior — can start because of peer pressure.

Does education about the dangers of drugs work? Aren’t most people aware by now of the risks associated with heroin and prescription drugs? What are the most effective prevention strategies?

This is a very controversial topic. The Partnership for a Drug-Free America was criticized because it hasn’t eradicated the use of drugs. All education is good and valid, and other deterrents are also needed. For example, education should start earlier and be provided more frequently throughout the school years. Parents should be educated about the drugs and risks, as well, and they should reinforce this education with their children. Parents should also be instructed to keep medications locked and out of reach of children, and they should keep their children busy in positive, supervised activities.

Information is available from numerous resources, including the internet and apps to appeal to youth’s preferences for technology-based communication. However, prevention remains a challenge because many adolescents and young adults feel invincible and the impulse-control part of their brains is the last to develop, around age 25. Nevertheless¸ prevention is not impossible. Multiple, ongoing strategies — and funding to implement these strategies and for related resources — are needed.

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I applaud Assemblyman Jack Ciattarelli’s plan to provide funding for middle and high school programs to educate students about the dangers of prescription drugs and heroin, and I agree with him that educating youth is just one necessary aspect of education. All health care providers should be required to be educated about the inherent addiction risk of opiates, how to identify addiction and how to refer patients and their families to appropriate resources.

All health care providers also should be required to counsel their patients for whom they prescribe opioids about the potential harm and risk of addiction and to monitor these patients. They should also be knowledgeable about alternatives to opioids, including other types of medications and non-medication treatments. Such alternatives are especially critical for patients who have a history of addiction and/or if they already have prescriptions for opioids. This can be determined through the Prescription Monitoring Program, which all health care providers should be required to use.

What are the biggest fallacies about opioid addiction?

The biggest fallacy is that the typical person with an addiction is poor, a criminal and living in an inner city. The truth is that anyone who is exposed to drugs can develop an addiction. The brain chemistry is what causes the addiction. It’s a disease.

In fact, the American Society of Addiction Medicine released its definition of addiction as a chronic brain disorder in 2011. “Many behaviors driven by addiction are real problems and sometimes criminal acts. But the disease is about brains, not drugs. It’s about underlying neurology, not outward actions,” said Dr. Michael Miller, past president of ASAM who oversaw the development of the definition.

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“We have to stop moralizing, blaming, controlling or smirking at the person with the disease of addiction, and start creating opportunities for individuals and families to get help and providing assistance in choosing proper treatment,” Miller rightly emphasized.

Fortunately, more than five years later, we have made significant progress toward eliminating stigma and discrimination, as evidenced by our state and federal leaders’ making addiction treatment a priority. However, more education is needed to fully eliminate stigma, not only among those who do not have addictions, but also among those who have the illness so they do not feel ashamed or embarrassed, which prevents a lot of people from seeking help.

In virtually any discussion of the heroin and opioid addiction problem, the conversation turns to the shortage of treatment facilities. What is the unmet need for inpatient and outpatient treatment? How long are the wait lists? Are they growing or shrinking?

The primary obstacle to inpatient admissions for addiction treatment appears to be lack of funding. Funding for the Driving Under the Influence Initiative (DUII), a primary resource for patients in the public system, is almost totally used by the end of the first week of every month. Funds from county governments are almost completely expended by the end of the third quarter of each calendar year. Recovery and Rebuilding Initiative grant dollars, administered by the state Division of Mental Health and Addiction Services (DMHAS) and created to provide access to inpatient detox and short-term residential services for those affected by superstorm Sandy who met very specific criteria, had served a great number of people during the approximately three years it was available. Now, providers of these services announce bed availability at various provider forums. Expanding treatment dollars that are not tied to specific initiatives would be helpful in improving access to care.

For outpatient for substance use services, Medicaid fee-for-service rates, which were implemented July 1, 2016, have been significantly increased. However, these rates are not sufficient for treating individuals with co-occurring mental illnesses, who account for 60 percent of individuals with substance use disorders.

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We hope these new rates will ultimately increase access. Recent data demonstrate tremendous unmet need. In 2014, nearly 590,000 adults in New Jersey needed treatment for alcohol abuse or dependence and approximately 350,000 adults needed treatment for drug abuse or dependence, according to a state 2016-2017 Block Grant application. This totals nearly 940,000 individuals. However, nearly 79,000 sought treatment and only 47,664 received treatment in 2014. This means almost 40 percent of those who sought treatment received it and only 5.1 percent of all New Jersey adults who needed treatment received it. This clearly illustrates the need for many more treatment beds.

It has been reported that the state has lost more than 40 percent of its substance abuse treatment beds for the poor and uninsured since 2010. From 2010 to 2015, the number of residential beds for insured New Jersey residents increased by almost 30 percent and the number of outpatient slots were increased 112.9 percent, according to DMHAS data.

From a public health standpoint, does it make sense for heroin users to be criminally charged?

Definitely not. What does make sense is to provide treatment. Treatment is humane, effective and cost-effective. It gives individuals opportunities to recover and become productive citizens. Without treatment, individuals will likely return to jail and continue struggling with addictions.

Integrity House and Hunterdon County Correctional Center (HCCC) have proven the effectiveness of treatment. HCCC developed a comprehensive program that includes addiction treatment that Integrity House provides at HCCC, and housing and job training, as well as continued treatment upon each individual’s release. This program reduced recidivism from 53 percent to 22 percent in 2013 and it saved the county hundreds of thousands of dollars.

Drug Court is another positive model. Rather than sending nonviolent offenders to jail, treatment is mandated, giving them opportunities as described above while reducing overcrowding in jails and the high cost of incarceration, compared to treatment.

WATCH: Advocates: More drug treatment beds needed 

What are the main reasons for the shortage of treatment facilities? Lack of government funding? Inadequate insurance reimbursement for private providers? Too few addicts who can afford private treatment?

A significant part of the problem is insufficient investment into bricks and mortar and capital costs for treatment facilities. There are also limitations on commercial insurance, which is accepted by both public and private providers. As the demand for services continues to increase, payments have not kept up with the cost of care, and people do not have insurance coverage, whether public or private, to meet the high costs.

Few people with addictions can afford to pay themselves. Those who have insurance in many cases cannot afford the high copays and deductibles. The federal parity law is a step in the right direction, but it does not go far enough and it is not fully enforced. Under the law, insurance companies that provide coverage for substance use and mental health services are supposed to do so at parity, which means that the annual and lifetime limits should not be lower than for physical health care, and the copays and deductibles should not be higher.

What coverage does the average health insurance policy provide for inpatient and outpatient treatment? About what percentage of addicts are covered by health insurance?

There is no average policy as they vary greatly in the individual and small-employer marketplaces. The percentage of individual with addictions who have health insurance is unknown.

What percentage of addicts have their addictions controlled in treatment programs? How long does recovery take?

As noted above, 2014 New Jersey statistics indicate that only 5.1 percent of all New Jersey adults who needed treatment received it. Nationally, the estimate is 11 percent.

The time frame for recovery varies. Addiction is a chronic illness. Just like with diabetes or heart disease, people can experience single episodes and relapses throughout their lives. Recovery can be a lifelong process with ebbs and flows. It depends on the person and other variables, such as life events and stressors. This reinforces the need for access to all levels of treatment at all times.

WATCH: Heroin, opioid addiction crisis explored at St. Barnabas Medical Center

Some people contend that the expansion of drug courts, in which nonviolent drug offenders can avoid jail time by receiving drug treatment, have absorbed many of the scarce inpatient beds, making it increasingly difficult for addicts who have not been in trouble with the law to get treatment. True? If so, what should be done about that?

Drug Court might contract for a certain number of beds and if they are not used, other individuals can then use those beds.

From a prevention and treatment perspective, what are the three most important things the state Legislature should be doing to help address the heroin/opioid addiction problem?

Increase funding to expand prevention services, increase funding to expand treatment services and increase funding to expand recovery support services.

There are many others essential initiatives as well. These include mandating that all health care providers use prescription drug monitoring programs and requiring that all prescribers become educated about opioid alternatives.

Debra L. Wentz is president and chief executive officer of the New Jersey Association of Mental Health and Addiction Agencies and executive director of its nonprofit charitable organization, the New Jersey Mental Health Institute. NJAMHAA represents 160 nonprofit hospital-based and freestanding behavioral healthcare provider organizations that treat and provide supportive and recovery services to more than 500,000 children and adults annually.