Gov. Paul LePage is proposing sweeping legislation that would, among other things, place strict new limits on the maximum dose of opioids that could be prescribed by a doctor in any single day.
The bill takes a much more restrictive approach than another proposal that’s before the Legislature.
With Maine’s drug crisis continuing to claim lives, LePage has introduced a measure aimed at limiting the amount of prescription drugs being prescribed and forcing prescribers to take part in the state’s prescription monitoring program.
He outlined the bill at his town meeting in Waldoboro.
“I have got a bill in to require physicians who prescribe drugs to not only register with the prescription drug monitoring program, but to use it,” he says. “And if they don’t use it, they lose their ability to prescribe. Period.”
The bill also would limit the size and duration of prescriptions for opioids, and require additional training for all prescribers. It would also require that all opioid prescriptions be submitted electronically to pharmacists as of 2018.
Department of Health and Human Services Commissioner Mary Mayhew says the measure is needed to help address the drug crisis.
“We know that prescription pain meds are a gateway to heroin addiction,” she says. “We’ve got to be prepared to look very differently at the practice of medicine and particularly at the use of opiates.”
But some of the provisions of the governor’s bill are raising concern among prescribers.
The measure would limit opioid prescriptions to a maximum that is the equivalent to 100 milligrams of morphine. Gordon Smith, the executive vice president of the Maine Medical Association, questions legislating such a limit without allowing a doctor to use their professional experience.
“We would like to have these kind of difficult issues that really involve the practice of medicine dealt with at the licensing board level and not by the Legislature as a whole,” he says.
But the actual language in the governor’s proposal may not be as arbitrary as it first appears. Dr. Chris Pezzullo, the state’s chief health officer, says he does not see the daily limit in the proposal as absolute, but rather should be looked at as the target for prescribers.
“Certainly there will be exceptions that will be written in — somebody who is dying of cancer, for example, somebody who has end of life care, somebody who may have had a massive life-threatening injury and may need a higher dose for a shorter period of time,” he says. “This is really a threshold, a target you are aiming for.”
But rather than writing such exceptions into state law, Augusta state Sen. Roger Katz, a Republican, is proposing legislation that would require the various licensing boards for prescribers to develop rules that could be more easily modified, providing more flexibility for prescribers as they treat patients on a case-by-case basis.
“We have got to crack down on the overprescription of medication, we have got to crack down on doctor shopping, we have got to crack down on prescription diversion,” he says. “This bill would accomplish that.”
Katz and the Maine Medical Association agree that more prescribers need to make use of the prescription monitoring program and that more training is needed. That could form the basis for a compromise bill this session.
Public hearings on the two measures have not yet been scheduled.
