AUGUSTA — The LePage administration and a lobbying group representing doctors agreed Friday to a compromise on a bill that aims to reduce the amount of prescription opioids that are flowing through the state.

The administration proposed limiting opioid prescriptions to three days for acute pain and 15 days for chronic pain, and capping dosages at 100 morphine milligram equivalents per day.

Under the compromise, the administration agreed to lengthen the maximum time for prescriptions to seven days for acute pain and to 30 days for chronic pain, in part because some rural residents must travel long distances to pick up prescriptions.

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.

The compromise leaves most of the administration’s proposal in place – including the cap on opioid dosages. The Legislature’s Health and Human Services Committee discussed the compromise Friday but tabled the bill in order to bring it up again in the coming weeks.

Gordon Smith, executive vice president of the Maine Medical Association, which represents physicians, said he believes all but one lawmaker on the committee supports the compromise measure.

The Maine Department of Health and Human Services has estimated that about 350,000 Mainers were prescribed a total of 80 million opioid pills in 2014, the latest figures available. Research shows opioids are ineffective and often counterproductive for treating chronic pain, leading pain physicians have told the Portland Press Herald.

Meanwhile, Maine is undergoing a heroin epidemic, with drug overdose deaths reaching 272, an all-time high, in 2015. About 15,500 Mainers were receiving treatment for opioid addiction in state-sponsored programs in 2015, according to Maine DHHS.

DHHS Commissioner Mary Mayhew said she’s “extremely excited” that the bill is receiving strong support, and she believes the changes would help limit the number of Mainers at risk of becoming addicted to opioids through prescriptions.

“This bill will address the issue of how prescribing opioids has contributed to opioid addictions,” Mayhew said. “I am confident this will make significant changes.”

Four out of five new heroin users develop their addictions as a result of prescription opioids, according to the American Society for Addiction Medicine.

Smith said doctors normally resist efforts to legislate medical practice, but in this case the changes are necessary.

“We had to do something. There’s a serious problem out there,” Smith said. “There is definitely overprescribing going on, and we have to change the culture, both for the doctors and the expectations by the patients.”

He added, “Too many times, people are walking out after having a minor procedure done with 30 or 60 Percocet.”

The compromise creates exceptions to the maximum dose limit for end-of-life, cancer and palliative care patients. Smith said more exceptions could be added as needed. The dose maximum closely coincides with prescribing guidelines released this week by the U.S. Centers for Disease Control and Prevention.

Patients who need another prescription can seek one from their doctor, but the prescription would have to be medically justified. With a state law setting a 30-day maximum for chronic pain, insurance companies may start requiring prior authorization before reimbursing for new prescriptions beyond the initial 30-day prescription, Smith said.

If approved by the Legislature, the law would go into effect Jan. 1, 2017, which would give current patients who are on dosages higher than 100 morphine milligram equivalents several months to taper to the new standard.

Smith said the medical association estimates about 20,000 to 25,000 patients exceed the 100 morphine milligram equivalents dosages and many of them would have to taper to the new standard. Some may be cancer, palliative or end-of-life patients and would be excluded from meeting the standard.

Massachusetts signed a similar measure into law this week.

If the bill is approved, Maine would join the 27 states that require doctors to use the state’s prescription monitoring program before prescribing opioids. Maine’s additional requirements on opioid prescribing would make it one of the strictest states in the country for laws on prescribing practices, a national expert told the Press Herald when the bill was introduced in early March.

 


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