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As New Rules Take Effect, Debate Continues Over Prescribing Opioids

Patty Wight
/
Maine Public

In just a few weeks, new limits on opioid prescribing will take effect in Maine.

Prescription pain medication continues to play a role in overdose deaths across the country, and a state law is designed to reduce abuse by curbing doses. But some lawmakers say the new restrictions in Maine will actually cause more harm to some patients, and they plan to introduce legislation to soften the law that was recently passed.

Noreen Alton-Jones of Standish knows the power of opioids.

“They make the pain go away, which is a good thing,” she says.

In 2007, Alton-Jones woke up one morning to searing pain in her left leg. She couldn’t move it. After trying a few different treatments to control the pain, her doctor at the time prescribed opioids to address problems with her sciatic nerve. And she says they were a huge help, at least, initially.

“But they also kind of like, your mind thinks things, and your mouth says it before you realize it. And you can’t really carry on a conversation because you lose track of what’s being said. And you more or less feel like nothing matters. No matter what’s going on in your life, it doesn’t matter,” she says.

Six years later, Alton-Jones was swallowing 15 pills a day. She says she had lost control of her life. But then a different doctor suggested she taper off.

“I never liked prescribing opioids,” says Dr. Kristen Silvia.

Silvia says opioids can be effective for acute pain, but if used long-term, patients develop a tolerance. They need more to achieve the same level of pain control.

“And I didn’t really see patients functionally doing well on these medicines,” she says.

So, Silvia identified about two dozen of her patients taking opioids for chronic pain and started scheduling appointments solely dedicated to pain management. The reality of chronic pain, she says, is it never completely goes away.

“The question becomes, how can they live with that pain, and what are the goals that they have in life, and what are the things that are important to them? What do they want to be able to do? And so when we focus on function rather than on pain level, that empowers the patient,” she says.

Silvia’s patients tried other treatments, like physical, massage and even behavioral health therapy to achieve their goals. Within 6-18 months, she says, her patients were able to either drop opioids altogether or drastically reduce their doses.

Noreen Alton-Jones is down to one pill a day.

“I’m able to do more. And my mind is — I’ve gone back to reading, which is something I couldn’t do before. Now I can read a 400-page novel in 2-3 days, and I actually maintain all the information,” she says.

But Alton-Jones’ experience is not shared by all patients, according to Democratic Sen. Jim Dill, who represents northern Penobscot County. Dill says many of his constituents have complained that since a new state law went into effect this summer, their prescriptions were suddenly reduced.

“I also had people say that because of the reduction in the pain medication, that some people were actually considering, and some people said that they actually knew people who were, turning to the street,” he says, to buy more pills. It’s an unintended consequence of Maine’s law that he says needs to be addressed.

Dill plans to introduce a bill that would give providers more flexibility in prescribing. But Gordon Smith of the Maine Medical Association says the problem is not with the law.

“They’re problems because people have misinterpreted the law, or intentionally misinformed patients of the law,” he says.

Maine’s law has a series of deadlines. When it first went into effect in July, any new opioid patients could receive a maximum of 100 morphine milligram equivalents per day.

But more than 16,000 existing patients above that limit can get exceptions until Jan. 1. They have some leeway until next July, when their prescriptions must meet the 100 morphine milligram equivalent threshold.

“About two-thirds of the law hasn’t taken effect yet,” Smith says.

It’s premature, he says, for lawmakers to chip away at a law before it’s fully implemented. Plus, Maine’s Department of Health and Human Services is expected to release rules this week to add exceptions to the prescribing limits.

But Democratic Sen. Geoffrey Gratwick, a rheumatologist, is also planning to introduce a bill to give doctors more flexibility to prescribe opioids. He says not knowing what DHHS will propose, he’d rather be safe than sorry.

“The bill that I think several different legislators and I will be introducing will somehow take into account these patients who, through no fault of their own, are on larger doses of this medication, and should not be left hung out to dry.”

But with someone in Maine dying about once a day from an overdose, Gordon Smith says the law needs time to work, and that it can be implemented compassionately.