BANGOR — Congratulations to the Portland Press Herald/Maine Sunday Telegram, the Kennebec Journal and the Morning Sentinel for the recent 10-day series “Lost,” bringing to readers’ attention the many lives lost because of drug abuse.
To lose 376 Mainers to this epidemic in a single year is simply horrific. As an emergency physician and as president of the Maine Medical Association, I see the impact of this scourge every day on Maine families and on our communities. No other illness or condition is causing the death of young and middle-aged Mainers at such a pace.
And the number of overdose deaths is just the tip of the iceberg, as there are many more overdoses in which people are saved with Narcan or they experience a non-life-threatening overdose. Taking these cases into consideration, the annual number of overdoses in Maine is surely in the thousands. Thank you for putting a very real face on these deaths.
Abuse of prescription medications and the use of heroin and other street drugs are not new issues here, nor are they unique to Maine. More than 50,000 Americans died in 2015 from similar abuse and incidents. Two-and-a-half years ago, Maine and the country were terrorized by the Ebola virus. Over a billion dollars was spent on that epidemic, in which only one person in this country died.
Why is the loss of tens of thousands of our neighbors not being addressed by all the public health measures and public and private resources that can be brought to bear? Only recently have substantial efforts been made in Washington, D.C., and in Augusta to provide more resources for treatment. Prevention efforts receive even less attention.
For nearly 20 years, the Maine Medical Association has dedicated resources to the issue of prescription drug abuse. We began a series of education programs, accompanied by information from the Maine Drug Enforcement Agency, as soon as reports surfaced of the diversion of OxyContin in Down East Maine. In 2004, we supported the establishment of one of the very first prescription monitoring programs in the country, creating a confidential, searchable database of all prescriptions for controlled substances dispensed in the state.
Last year, we worked with Gov. LePage and the 127th Maine Legislature to enact groundbreaking legislation limiting the amount of opioids that can be prescribed. This law has not been easy for either prescribers or patients, particularly those 16,000 patients who exceeded the legal maximum dose (100 milligrams, morphine equivalent) on the effective date of the law, but we continue to believe this was an appropriate response to harm done by these powerful medications.
We are still working to improve the law, including making additional appropriate exceptions. The recent announcement of a potential lawsuit by patients with chronic conditions simply demonstrates the difficulty of balancing the interests involved.
Many legislators have been besieged by patients on high doses of opioids for chronic conditions, some of whom have used these medications for many years and many of whom are dependent on these drugs. These patients believe these drugs are helping them, despite the more recent clinical literature establishing that there is no clinical indication for opioid medication for the treatment of chronic pain. Many patients have been successfully weaned from high doses of opioid medication. Other patients have been found to suffer from substance use disorder and are being treated with Suboxone or other medication-assisted therapy.
Each and every patient is unique and deserves a treatment regimen appropriate to their underlying illness or condition and responsive to their symptoms, including pain. That is why the new law and rule already provide a number of exceptions.
While the pendulum may have swung a bit far in attempting to respond to the horrific toll the epidemic is taking, society will never achieve the perfect balance between the legitimate needs of patients experiencing pain and the need to prevent diversion, dependency, addiction and death. But the difficulty of the task should not deter us from trying to get this right. The needs of individual patients and the public demand it.