A compromise measure placing limits on the prescription of opioids in Maine is making its way though the Legislature. Though still in committee, it appears to have the support of the governor’s office as well as the Maine Medical Association.
The bill, which would set limits effective next year and include exceptions for cancer patients and others, was crafted from competing measures submitted by Gov. Paul LePage and and Republican Sen. Roger Katz.
Gordon Smith of the Maine Medical Association says his members were not comfortable with LePage’s three-day limit for acute pain and 15-day limit for chronic pain.
“Those time periods were way too short, they would be the shortest in the country,” Smith says.
So, the governor and the doctors group doubled the numbers and agreed on seven days for acute pain and 30 days for chronic pain. Smith says those limits conform to measures in place in other states.
Still, he says physicians in Maine are not comfortable with state mandates that regulate dosages of drugs.
“The most difficult thing for the doctors is really the average daily dose limit, because they’re not willing to grandfather the patients that are already on medication exceeding that limit, and we don’t believe that all those patients can be tapered off their existing medication,” Smith says. “So we did the best we could.”
But Smith says his organization understands why LePage believes that bold action is needed in response to the state’s opioid abuse crisis.
The compromise plan caps prescriptions at 100 morphine milligrams a day, which is in line with the CDC guidelines of 90 morphine milligrams a day. The plan also requires continuing medical education on proper pain management, that all practitioners use a patient’s prescription monitoring program and, where technically possible, physicians use electronic prescribing.
The LePage administration also agreed to a number of exceptions under the bill, specifically for those patients in active cancer treatment or palliative care or those under hospice care.
Smith says the legislation is one way to address the realities of opioid abuse in Maine.
“Unfortunately, even if 95 percent of the prescribers are really trying to work hard do the right thing, if only 5 percent aren’t, they can do a tremendous amount of damage, ” he says. “You see it with our increasing overdose deaths and babies born with signs of withdrawal, and so the medical community has stepped up to the plate and said we do own some of this, we don’t own all of it, we need to do some significant things to change the culture.”
“I think there’s broad support for what we’re trying to do here for the committee, there’s a lot of detail to be worked out.” says state Rep. Drew Gattine, Democratic House chair of the Legislature’s Health and Human Services Committee.
Gattine says there are aspects of the proposal that all members like, but the committee still wants to hear from other stakeholders before taking a vote on the measure.
Among the potential issues are how doctors will be able to demonstrate that they are watching patients under the prescription monitoring program — every 90 days.
“I think we’ve had some questions, and the mechanics of how the tool itself works — I think it’s kind of universally accepted that it’s kind of clunky,” Gattine says.
Rep. Richard Malaby, a Republican on the committee, says he’s glad that the doctors group and the administration had agreed to include benzodiazepines, or benzos, on the opioid list.
“I think they are overprescribed,” Malaby says. “I know that in my area, the doctors who prescribe suboxone, the treatment doctors, you know, if someone goes through treatment or detox, they come out and they wrote them a script for suboxone — they also give them a couple of benzos, and I don’t quite understand it.”
Lawmakers on the Health and Human Services committee say they want to receive more information before taking up other details of the bill, including those creating rulemaking procedures for establishing possible new exceptions to the opioid restrictions.