Doctors and other professionals who prescribe narcotics in Maine have begun to develop new rules aimed at reducing the amount of prescription painkillers available for abuse and diversion.
The group, which met Tuesday at the Augusta offices of the Maine Board of Medical Examiners, will expand existing guidelines for medical doctors to be used by other prescribers in managing both chronic and acute pain.
For treating chronic pain, the expanded guidelines may include the use of a formal contract between the patient and the prescribing clinician, random urine checks and pill counts to detect abuse or diversion. They also call for improved assessment, revision and documentation of the patient’s pain and the effectiveness of the treatment.
Attending Tuesday’s meeting were representatives from the state boards of osteopathy, nursing, dentistry, pharmacy, podiatry and veterinary medicine. The makeup of the group, which includes all professions allowed to write prescriptions, is mandated in a legislative resolve passed earlier this year, sponsored by Sen. Peter Mills, R-Skowhegan.
Mills, a lawyer and longtime legislator, said in a telephone interview Tuesday that undertreated pain emerged as a concern within the medical profession about 10 years ago. Physicians and other clinicians, who had been criticized for fretting about drug dependency and addiction in their dying patients, rededicated themselves to easing pain associated with cancer and the end of life, using the most effective narcotics available.
“The problem is that, when that movement took hold, it also became OK to use narcotics to treat chronic, nonterminal, noncancerous pain,” Mills said. Pain from disorders such as back injuries, joint disorders and fibromyalgia — which can last a lifetime — could be managed with powerful, addictive opioid drugs such as OxyContin. As a result, Mills said, the street availability of such drugs increased dramatically, along with rates of abuse, addiction and overdose deaths.
“The number of deaths from prescription overdoses increased from 30 a year in the mid-’90s to 150 a couple of years ago,” Mills said. “In 2008, there were 343 drug-affected babies born to women who abused opioid drugs while they were pregnant.”
Mills believes that by educating all clinicians about the dangers of overprescribing, and by holding them to a standardized, formal protocol for managing patients who do need narcotics, the street supply of dangerous and addictive drugs will decrease.
Medical doctors, osteopathic doctors and nurse practitioners are the most important groups to reach, he said, but all prescribers — even veterinarians — should understand the significance of the new protocol.
Candyce Powell, executive director of the Maine Hospice Council, said she was reassured at Tuesday’s meeting that the focus of Mills’ resolve is on managing chronic pain and not the pain associated with cancer and the end of life.
Nonetheless, she will monitor the rulemaking closely.
“It’s a fine balance, knowing how to dose properly, to use the correct medication in the correct circumstance,” Powell said. The Maine Hospice Council has developed its own educational program for physicians treating cancer pain.
Randal Manning, executive director of the Maine Board of Medical Examiners, said Tuesday that the initial meeting “went off well,” with general agreement reached that tightening up prescribing protocols will help rein in rates of illicit drug use, overdose and crime.
The group will meet several times over the coming months to refine a standard protocol for all prescribers, he said,
The rule will be written to allow physicians and other prescribers “great discretion” in treating chronic pain while still providing guidelines for identifying drug-seekers, preventing patients from getting prescriptions from multiple providers, and referring long-term patients periodically to pain management specialists for evaluation, according to Manning.
The Board of Medical Examiners must report on the new rule in February to lawmakers on the Legislature’s Business, Research and Economic Development Committee.