AUGUSTA — Health care providers were mostly supportive of two bills that would impose restrictions on opioid prescribing in Maine, but argued in a legislative hearing Wednesday for more flexibility in a LePage administration bill that would regulate the doses and length of prescriptions.

Abuse of prescription opioids often leads to heroin addiction, studies have shown, and Maine is currently undergoing a heroin crisis.

Dr. Stephen Hull, director of pain management at Mercy Hospital’s Pain Center, said numerous studies on the topic are conclusive – opioids do not work for controlling chronic pain.

“The chronic use of (prescription) opioids actually makes pain worse,” Hull told the Legislature’s Health and Human Services Committee.

The administration’s bill would limit opioid prescriptions to three days for acute pain and 15 days for chronic pain, and cap dosages at 100 morphine milligram equivalents per day. The bill also would mandate usage of the Prescription Monitoring Program, a database created to prevent patients from “doctor shopping.” And the measure would require doctors to undergo training before being permitted to prescribe opioids.

Maine’s opioid prescription laws would be among the strictest in the nation if the administration’s bill were approved, a national expert told the Press Herald on March 2, when the proposal was introduced.


A similar bill by Sen. Roger Katz, R-Augusta, would mandate use of the monitoring program, but it doesn’t impose limits on prescription lengths or dosages.

Hull said he supports LePage’s bill but would like to see amendments that would make exceptions for cancer patients, terminally ill patients and those who have been taking opioids for many years.

Dr. Christopher Pezzullo, Maine’s Chief Health Officer, said he would work to carve out exceptions for cancer and end-of-life patients, and he agreed that something should be done for patients who have been taking higher doses for many years. For those patients, Pezzullo said a long-term tapering program would be appropriate.

But Pezzullo said the dosage and time limitations are strongly supported by science, and coincide with new guidelines released by the U.S. Centers for Disease Control and Prevention this week that suggest curtailing of opioid prescriptions. This week, the Massachusetts Legislature approved and Gov. Charlie Baker signed into law the mandated use of the Prescription Monitoring Program and limits on opioid prescriptions to seven days.

Pezzullo said the administration’s bill would prevent many people from becoming addicted to opioids. Four of five new heroin users first become addicted to prescription opioids, according to the American Society of Addiction Medicine.

Mainers are dying at record rates from opioid overdoses. The vast majority of Maine’s 272 drug overdose deaths in 2015 – an all-time high – were due to heroin, fentanyl, prescription opioids or a combination.


Pezzullo said many times opioids are counterproductive, so their use should be greatly restricted.

“A common side effect of opioids is hyperalgesia – an increased sensitivity to pain,” Pezzullo said. “The very drugs used to treat chronic pain make you feel pain more acutely, forcing the need for ever higher dosages in order to limit the sensation of pain.”

Pezzullo pointed to studies that showed a combination of low-dose acetaminophen and ibuprofen were more effective at controlling acute pain.

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. Meanwhile, about 15,500 people received treatment for opioid abuse at a state-sponsored program in 2015, according to Maine DHHS.

Sen. Andre Cushing, R-Newport, sponsored the administration’s bill and said he’s proposing the additional regulations as another way to combat the heroin crisis.

“Those who take opioid painkillers are 40 times more likely to become addicted to heroin,” Cushing said. “I believe it is time for some rational limits and safeguards on the prescribing of opioid pain medications.”


Gordon Smith, executive vice president of the Maine Medical Association, which represents doctors before the Legislature, said his members support the bills, but lawmakers should be careful about mandating prescribing practices.

Smith said lawmakers should not put themselves “in the exam room between the prescriber and the patient.”

“The governor’s bill sets arbitrary and very strict standards for the amount and duration of pain medication that can be prescribed,” he said.

Dr. Elizabeth Hart, a Mount Vernon family physician, opposed the LePage administration’s bill on grounds that it hampers the ability to practice medicine.

“The complexity of the clinical treatment of patients with complex pain requires individualized care that would be made impossible with blanket limitations,” Hart said.

Pezzullo said he’s pleased that reaction to the bill has for the most part been supportive.

“The professional medical community recognizes that there has been a problem, and they want to be part of the solution,” Pezzullo said.


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