The state of Maine could set its own prescribing limits on opioids if lawmakers approve a pair of bills presented to the Health and Human Services Committee today.
One bill, backed by Gov. Paul LePage, would set strict criteria for how much and how often clinicians can prescribe the painkillers.
Another bill from Republican Sen. Roger Katz directs medical licensing boards to establish prescribing limits. The bills come after this week’s first-ever release of guidelines by the U.S. Centers for Disease Control on prescribing opioids.
Gov. LePage wants bold action to make a difference in the opioid abuse crisis, says his senior policy advisor David Sorensen. His bill delivers, Sorensen says, by reducing unnecessary opioid prescriptions.
"This bill caps prescriptions at 100 morphine milligrams a day," says Sorensen.
Compare that to the new CDC guidelines, Sorensen says, that caution against prescriptions that exceed 90 morphine milligrams a day. He says other provisions of the governor’s bill are also in line with the CDC recommendations.
Sorensen says, “The bill limits scripts to three days for acute pain and fifteen days for chronic pain. They recommend three to seven days for acute pain.”
The bill also requires clinicians to undergo training for prescribing opioids and to check patient information in the state’s Prescription Drug Monitoring Program when ordering prescriptions.
Attorney General Janet Mills told committee members that she doesn’t always agree with the governor, but she supports this bill because Maine can’t afford not to take action.
“Out of the 272 individuals who died last year from drug overdoses, 111 of those died primarily due to prescription drugs,” says Mills.
The governor’s bill drew general support in the public hearing for its efforts to reduce opioid abuse. However, certain provisions – like the prescribing limits – drew concern. Gordon Smith of the Maine Medical Association likened the governor’s proposed caps to a blunt instrument in the treatment of patients who have individual needs and by doctors who must make nuanced decisions.
Smith says, “What they objected to most strongly, and we’ve heard from hundreds, is when you get in the examination room with your limit – the average daily dose limit – and stand between them and their patient, what they think is needed for their patient to continue their care, they really bristle at that.”
Others, like Hilary Schneider of the American Cancer Society, say the governor’s bill should provide exemptions on prescribing limits for certain patients.
“According to the National Cancer Institute, use of opioids for the relief of moderate to severe cancer pain is considered necessary for most patients,” says Schneider.
Dr. Elizabeth Hart points out that some hospice and palliative care patients also legitimately benefit from high doses of opioid painkillers.
“I don’t think this is just end-of-life pain. People can receive palliative care for many years, even while pursuing curative treatment, and they may require escalating higher and higher chronic opioid doses,” Hart says.
Hart, along with the Maine Medical Association, told the Health and Human Services Committee that they prefer Sen. Roger Katz’s bill, which would direct licensing boards to develop appropriate opioid prescribing standards for clinicians. They did say that they could support the governor’s bill if it is amended to loosen the prescribing caps and to provide some exceptions. The CDC guidelines do include exemptions for cancer, palliative, and end-of-life care.
