New Dosage Law Means Opioid Patients Must Make Changes

By Amy Jeanroy

About 16,000 Mainers are currently prescribed high doses of opioids for chronic and acute pain, and a new law taking effect, LD 1646, “An Act To Prevent Opiate Abuse by Strengthening the Controlled Substances Prescription Monitoring Program,” will be affected by the stricter mandate.  

The law, which took effect this past Friday, will make Maine the third in the nation to set a cap on the daily strength of opioid prescriptions. Maine's limit is now 100 MME per day, while the other two states, Washington and Massachusetts have a cap of 120 MME. The Center for Disease Control has issued a lower guideline of 90 MME. Patients currently receiving opioid pain medication have a 300 MME cap until July 2017 to give them time to transition to a lower dose. 

Along with the new MME cap, the new law caps scripts for acute pain at seven days and for chronic pain at 30 days beginning in January 2017. The board overseeing health care professions to incorporate three hours of training on opioid addiction into the 40 hours of existing Continuing Medical Education coursework required by boards every two years. The law also requires prescribers to submit  opioid and Benzodiazepine scripts to pharmacies electronically by July 2017. 

This new electronic prescription monitoring program (PMP), opioid prescribers will be required to check the statewide database before writing scripts for opioids or benzodiazepines that are to be filled and administered outside of a licensed health care facility. Right now,  as few as seven percent of prescribers use the PMP. 

"This is a prevention bill and it is designed to get at one of the root causes of the heroin crisis in Maine," says Dr. Christopher Pezzulo, Chief Health Officer for Maine DHHS and the leading clinician behind the bill.

According to the American Society of Addiction Medicine, about three of four new heroin users first abused prescription painkillers. 

In a 2014 report by the U.S. Centers for Disease Control and Prevention, Maine has the highest rate in the nation of prescriptions issued for long-term, extended release opioids. The long-term opioids, prescribed for chronic pain are the most likely to be abused. Maine doctors were prescribing these opioids at a rate more than twice the national average, according to the report. Opioids have no proven efficacy for the treatment of chronic pain," says Dr. Elizabeth Fowlie Mock of Holden. The medical definition of chronic pain is mild or severe pain that lasts more than three months. 

 

Penobscot Community Health Care employees say 28,000 Maine people have an opioid use disorder but only several thousand can receive treatment due to the capacity of facilities in Maine.