Maine seeks strong limits on opioid prescriptions


AUGUSTA, Maine (AP) — The Maine Legislature is poised to pass a bill sponsored by Gov. Paul LePage that would put the state on the front line of a national movement to monitor and restrict opioid painkillers.

The Republican’s bill would limit prescriptions to seven days for acute pain and 15 days for chronic pain, and cap dosages at 100 morphine milligram equivalents per day. That’s a lower threshold than the 120-milligram cap in Massachusetts and Washington, the only states that have mandatory statewide caps.

The bill would also require doctors to enter prescriptions into a state database created to prevent patients from “doctor shopping.” Databases are already in place in seven other states, including Massachusetts, Connecticut and New York.

The Maine bill is a “pretty aggressive move,” said Tom Clark, a manager at the Prescription Drug Monitoring Program Center of Excellence at Brandeis University in Massachusetts. “It’s part of a broader movement nationally to adopt this sort of legislation.”

Opioid drugs, which include medications like morphine and oxycodone as well as illegal narcotics like heroin, are considered a gateway to heroin.

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.

People who take opioid painkillers are 40 times more likely to become addicted to heroin, Assistant Majority Leader Sen. Andre Cushing told lawmakers when he introduced the bill earlier this month.

“For years, opioid pain medications have flooded our communities and have gotten many law-abiding and healthy people hooked,” said Cushing, a Republican from Hampden.

Dr. Stephen Hull, director of pain management at Mercy Hospital in Portland, which promotes alternative pain relief strategies, said there is significant evidence that treating chronic pain with high dosages of opioids makes the pain worse.

The Centers for Disease Control and Prevention two weeks ago released the first-ever national guidelines for prescribing opioids, urging doctors first to try non-opioid painkillers, physical therapy and other methods for treating chronic pain.

The recommendations represent an effort to reverse nearly two decades of rising painkiller use, which public health officials blame for a more than four-fold increase in overdose deaths tied to the drugs. In 2014, U.S. doctors wrote nearly 200 million prescriptions for opioid painkillers, while deaths linked to the drugs climbed to roughly 19,000 — the highest number on record.

The White House recently sent letters to all 50 U.S. governors recommending that they require doctors to check state databases and require pharmacists to upload drug dispensing data on a daily basis.

In Maine, a legislative panel last week endorsed the LePage bill in an 11-1 vote, and the House and Senate are expected to vote on it early next month.

While the bill would limit the length of prescriptions, it would not prevent doctors from renewing prescriptions.

The Maine Medical Association, which normally opposes bills that dictate how doctors treat patients, was initially uncomfortable with it. But the group agreed to support the bill after the LePage administration made exceptions for cancer patients, terminally ill patients and those who have been taking opioids for many years.

Hull, the Mercy pain specialist, said doctors and lawmakers approach the issue with different perspectives.

Lawmakers feel they need to respond to the drug crisis, he said. Doctors worry about how new rules affect individual patients. Some patients, for example, would suffer if dosages were lowered because years of opioid use has changed their brain chemistry, he said.

“The reality is that doctors by the nature of what they do are more interested in the individual sitting across them in the examining room than they are about society’s needs,” he said.