June 21, 2018
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Drug crisis may require tough choices

Maine is in the midst of an opioid explosion and our region is being rocked the hardest.

As the Sun Journal reported Sunday, oxycodone sales in Oxford and Androscoggin counties were up four-fold between 2000 and 2010, the highest rate of increase among 11 zones in Maine, with retail sales going from 11,085 grams in 2000 to 47,405 grams in 2010.

Hydrocodone sales in Androscoggin and Oxford counties were up equally high, again the highest rate in the state.

Oxy and hydrocodone are narcotic, morphine-like medications, although oxycodone is generally considered stronger and has a greater potential for abuse.

Forecaster writer Matt Hongoltz-Hetling recently reported that so many painkillers were prescribed in 2010 that they could have supplied every man, woman and child in Maine with 78 five-milligram doses, according to U.S. Drug Enforcement Agency statistics.

The consequences of the abuse are being felt across the state, although the exact dimensions of the problem may not be clear to many Mainers.

The most troubling indicator is the rising death toll. More Mainers now die from accidental prescription overdoses than in car accidents.

But it is harder to calculate the additional costs to society, including lost productivity, treatment, crime and the incarceration of people for drug-related and drug-motivated offenses.

State Rep. and U.S. Senate Candidate Jon Hinck, D-Portland, submitted legislation in 2010 that would have mirrored an aggressive prescription painkiller law passed in 2010 by the Washington state Legislature.

That law set a per-patient threshold for maximum opiate use. After that threshold is reached, patients fall into a continuing use category and their doctors are subject to a host of additional regulatory requirements.

Many Washington state doctors simply stopped prescribing painkillers and the law left some patients in pain and without medication, a condition many called inhumane.

Washington state has acknowledged the law’s shortcomings and is working to fix them, but the law — the toughest in the land — remains.

Hinck’s bill gave Maine lawmakers the chance to address the crisis head-on. But after a task force report, lawmakers adopted several far less aggressive reforms.

Hinck called the new provisions “weak tea.”

Maine may eventually come to the same conclusion as Washington state, that the crisis warrants a tougher approach.

Until then, we should be closely monitoring that state’s program to better gauge its overall impact.

In the absence of true reform, the crisis here seems likely to grow.

One thing physicians can do right now is register for and use the state’s Prescription Monitoring Program.

The law connects prescribers and pharmacists with a database that records individual patient purchases of restricted drugs. Doctors receive a notification letter when a patient has crossed a threshold for multiple prescribers, pharmacies or drug levels.

Prescribers can also check patient “profiles” before prescribing or extending prescriptions. The database is designed to prevent “doctor shopping” and “pharmacy hopping.”

It’s an excellent tool and, if used conscientiously, could go a long way toward identifying Mainers at risk and helping them find pain relief alternatives.

About half of Maine’s prescribers are registered to use the system, and that number must increase for the program to be effective.

Maine has a deadly problem, and the monitoring program can make a difference.

The Sun Journal (Lewiston, Maine) (May 3)

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