AUGUSTA — Maine lawmakers heard testimony Thursday from several chronic pain patients who say they are being unfairly harmed by a law that passed last year meant to tighten opioid prescribing practices.
The law, which improved the state’s prescription monitoring program and set prescribing limits, passed as part of legislators’ efforts to attack the supply side of an increasingly deadly crisis.
Some, though, believe it goes too far.
Anthony Bruno, of Berwick, said opioid painkillers are the only things that help his degenerative disc disease. Now, he has been forced to taper down his dose, based on the limits in the law.
“My quality of life has dropped,” he said.
Bruno, along with nearly a dozen others, testified in support of a bill sponsored by Rep. Geoffrey Gratwick, D-Bangor, that seeks to clarify the law and allow patients like Bruno to continue receiving an appropriate dose from their doctors.
The new law says that the total amount of opioid medication prescribed to a patient may not exceed 100 morphine milligram equivalents per day. There are some exceptions, for terminal cancer patients, for instance, and for those seeking palliative care.
Gratwick said the state’s position in enforcing the law is that patients like Bruno fall into the category of palliative care, but the term’s definition is not clear. He said many doctors take “palliative care” to mean people who are at the end of their life, not people who are managing chronic pain.
Many doctors – and Gratwick is one himself – still tell patients they need to taper down their doses to meet the law, even if they fit the defined exception, he said.
That’s what happened to Bruno. And the risk of going to a different doctor would mean Bruno might be accused of “doctor-shopping.”
EXEMPTIONS WITHOUT BIG CHANGES
Gordon Smith of the Maine Medical Association agreed with Gratwick that doctors are gun-shy but he said he has reservations about making major changes to the law.
“This law has done a lot of good,” Smith said. “But there is a disconnect and I think we can do more to educate doctors.”
Smith also said there is probably a way to carve out exemptions for long-term opioid users, although he worried about the term “palliative care” being too broad.
Last month, an attorney representing two midcoast men filed a notice of intent to file a lawsuit over the section of the law that requires long-term users of prescription opioids to lower their doses.
Patrick Mellor, of Rockland, told lawmakers Thursday that he’s heard from dozens more patients since he announced his intent and said lawmakers have an obligation to address this issue.
Thursday’s debate was the latest to highlight the disconnect between lawmakers who feel pressure to address the state’s opioid crisis and doctors who just want to treat their patients.
Last year, 376 people died from drug overdoses in Maine, most from opioids. As many as three out of four heroin users first become addicted to prescription opioids, according to the American Society of Addiction Medicine.
But not everyone who uses opioids becomes addicted. Rep. Seth Berry, D-Bowdoinham, said he’s heard from constituents who, like others, are being forced to taper down opioid doses because of the law.
“The legislation that passed had the best of intentions but we may have overreached slightly,” he said.
16,000 LONG-TERM OPIOID USERS
Dr. Christopher Pezzullo, representing the state Department of Health and Human Services, opposed changes to the prescribing law. He said the palliative care exemption should be enough to accommodate nearly all of the patients who spoke Thursday.
The state has estimated that there are as many as 16,000 long-term opioid users in Maine. One of the major risks of forcing patients to reduce the level of opioids they take is that they might turn to illicit opioids.
The Health and Human Services Committee plans to hold a work session on Gratwick’s bill before voting.
Eric Russell can be contacted at 791-6344 or at: