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Maine Broadens Exemptions For Toughest-In-Nation Opioid Prescription Limits

Patty Wight
/
Maine Public
Dr. Donald Medd

It’s been a year since Maine enacted the toughest opioid prescription limits in the country, which came in response to an addiction epidemic where, according to the U.S. Centers for Disease Control, nearly half of all opioid overdose deaths involve a prescription painkiller.

But some chronic pain patients in Maine railed against the restrictions, and the Legislature recently took action to make exceptions easier.

Name a surgery, and there’s a decent chance Ed Hodgdon has had it.

“Knee replacement, hip replacement, elbows. I’ve got screws in my feet,” he says.

The surgeries, more than 20 of them, were for Hodgdon’s rheumatoid arthritis. Along with those surgeries came opioid prescriptions for pain. But Hodgdon says the pain never went away.

“It just numbed it for awhile, and I needed more,” he says.

Hodgdon says over time, he needed a higher dose, before he found Dr. Donald Medd, a general internist in Westbrook.

“That’s my angel right there,” Hodgdon says.

Medd helped Hodgdon taper off his opioids in 2014, well before Maine's law went into effect last July, capping new prescriptions to no more than 100 morphine milligram equivalents — the standard used to measure potency — per day.

Patients with existing prescriptions were given a year to taper down and adjust. Medd was ahead of the curve because he noticed many chronic pain patients grew angry about their pain and demanded more medication. At the same time, they struggled to function in daily life.

“At some point the medications get in the way of some sort of recovery,” Medd says.

Hodgdon says pain medication affected his mood and his memory. Medd cut Hodgdon’s opioid prescription in half, and connected him to a therapist to address his emotional struggles with rheumatoid arthritis.

Hodgdon says he experienced withdrawal symptoms for about a month, but now his prescription is well below the allowable limit. His pain is the same as when he was taking high-dose opioids. But he says his life is infinitely better.

“I can remember things. I get along better with people,” he says.

Even though Medd has witnessed success stories like Hodgdon’s, he initially opposed Maine’s law, saying he didn’t want lawmakers interfering with medicine. But now he thinks it was a necessary nudge — his medical group has cut the number of chronic pain patients on opioids almost in half, from about 1,500 to 800.

Gordon Smith of the Maine Medical Association says overall, the state of Maine has seen a drop in painkiller prescriptions. He says it was a trend underway even before the law took effect.

“We had the fourth largest drop in the country. Twenty-one point five percent reduction in opioid prescriptions, from 2013 through 2016,” he says.

That data only includes the first few months of Maine’s new law, but Smith says he expects the law will accelerate further reductions.

“Now having said that, it has not been easy. It has been particularly difficult for patients,” he says.

It has been especially difficult for the 16,000 Maine patients on high-dose opioids who were expected to taper to the 100 morphine milligram limit by July of this year.

“I was about four times above that,” says Brian Rockett, who says he started taking opioids for pain decades ago after he got into several accidents racing motorcycles and boats.

Rockett operates a wholesale lobster buying business. He uses alternative therapies to alleviate his pain, but he says opioids allow him to do his physically demanding job. When he tried tapering off, he says he had unbearable pain. He filed an intent to sue the state.

“I just knew that I was facing possibly losing my business,” he says.

“A certain group of people simply cannot come off it,” says Geoffrey Gratwick, a retired rheumatologist and state senator who recently pushed through a change to the law that allows broader exemptions, so that people with incurable, chronic conditions can take high doses.

“It put the decision about that — those — back into the hands where it should be, the doctor and patient,” he says.

Under the revised law, Rockett was able to increase his dose and dropped the lawsuit.

Even though more patients could potentially seek exemptions, the restrictions are seen as an important step. Recent data from the US CDC found that nationwide, despite an overall decrease in recent years, the number of opioids prescribed is still triple what it was in 1999.