A bill introduced Wednesday by the LePage administration to combat Maine’s heroin crisis would create new restrictions on prescribing opioids to control pain that would be among the strictest prescribing standards in the nation.
About 75 percent of new heroin users first become addicted to prescription opioids, according to the American Society of Addiction Medicine.
“This is a prevention bill,” said Dr. Christopher Pezzullo, chief health officer for the Maine Department of Health and Human Services. “There’s way too many opioids in our communities.”
Maine is in the midst of a heroin crisis, and in recent years has experienced a surge in overdose deaths and the number of people seeking treatment for opioid addiction. About 350,000 Mainers were prescribed a total of 80 million opioid pills in 2014, according to the latest figures available from the Maine DHHS.
Under the new restrictions, doctors would be required to check the Prescription Monitoring Program before prescribing opioids, and would have to undergo mandatory training before being permitted to prescribe opioids, among other reforms. The Prescription Monitoring Program is designed to prevent patients from “doctor shopping” by limiting duplicate prescriptions for opioids.
‘A VERY AGGRESSIVE PROPOSAL’
Tom Clark, clearinghouse manager for the Prescription Drug Monitoring Program Center of Excellence at Brandeis University, which researches and tracks prescription monitoring programs and other regulations related to prescribing, said Maine’s regulations for prescribing opioids would be among the strictest in the nation if the bill is passed.
“This is quite a signal,” Clark said. “Maine is doing the right thing. This tells me they’re very serious about changing prescribing practices. It’s a very progressive proposal.”
Currently, 27 states require doctors to use the state’s prescription monitoring program before prescribing opioids, but Clark said in some states the requirements are weak and there are many loopholes.
Maine would join the dozen or so states that have a more comprehensive program, and the other requirements that Maine is proposing would put the state at or near the top for strict opioid prescribing regulations, Clark said.
Other measures in the bill include:
• Limiting opioid prescriptions for chronic pain to 15 days, and acute pain to three days.
• Capping opioid prescriptions to 100 morphine milligram equivalents per day.
Pezzullo said studies show that prescriptions higher than 100 morphine milligram equivalents have greater potential to be harmful to the patient. In a case study of eight states that included Maine, Maine had the second-highest percentage, at 15 percent, of doctors prescribing greater than 100 morphine milligram equivalents, according to a study published in October 2015 by the U.S. Centers for Disease Control and Prevention.
In addition, research has shown that overall, opioids are ineffective and many times are counterproductive in treating chronic pain. States are now examining ways to limit prescriptions for chronic pain.
“We are facing a heroin crisis that was created in large part due to the unchecked flood of prescription painkillers into our communities,” Gov. Paul LePage said in a written statement. “It’s time for some common-sense limits on prescribing these dangerous and highly addictive pills. With limits in place today, we can see a reduction in heroin addiction tomorrow.”
Pezzullo said the administration has been working on the bill for months, talking to experts across the country to devise a proposal that would make a significant dent in opioid prescriptions.
“If these measures had only been in place 10 years ago, I doubt we would have seen a heroin abuse crisis of today’s magnitude,” he said.
In 2012, the state made changes to opioid prescribing for MaineCare patients, and the state has seen opioid prescription rates for MaineCare, the state’s version of Medicaid, plummet in the past few years.
Opioid prescriptions in the MaineCare system declined by 45 percent from 2012 to 2014, while opioids prescribed using private insurance increased 5 percent during the same period, the Maine DHHS said.
But the bill unveiled Wednesday, if approved, would be much stricter than the MaineCare rules and would apply to all doctors in the state.
Clark, at Brandeis, said that as the heroin problem has become more acute, more states are adopting tougher rules for doctors who prescribe opioids. For example, mandatory physician use of prescription monitoring programs has been expanded to many more states over the past five years, he said.
SEEKING SYSTEM THAT WORKS FOR DOCTORS
Dr. Brian Pierce, president of the Maine Medical Association, a trade group that represents doctors and lobbies the Legislature on bills, said his organization agrees with the “intent” of the LePage administration’s proposals, but wants to make sure flexibility is built in so that doctors are not hamstrung by regulations.
“We want it to work well for patients and physicians,” Pierce said. The system should be designed so that if patients are having problems overnight or on weekends, doctors could prescribe the opioids without running afoul of state regulations, he said.
But Pierce said the association didn’t disagree with the goals of the bill or even with the idea that doctors should have mandatory training or be required to use the Prescription Monitoring Program. Pierce said over-prescribing of opioids has contributed to the heroin problem.
The bill, which was sponsored by Sen. Andre Cushing, R-Newport, the assistant Senate majority leader, could attract bipartisan support.
Rep. Drew Gattine, D-Westbrook, the co-chair of the health and human services committee, said he’s “open-minded” about the bill, and agrees that changes in prescribing practices should be considered by lawmakers.
The new regulations, if approved, would also apply to benzodiazepines, which are powerful sedatives used to treat a variety of conditions, including anxiety and panic disorders. Benzodiazepines also have been known to be diverted and abused.