As new MaineCare opioid restrictions take effect, hospital program to help with chronic pain

Posted Sept. 03, 2012, at 4:14 p.m.
Last modified Sept. 04, 2012, at 7:23 a.m.

BANGOR, Maine — With new limits set to take effect next year on how doctors in Maine prescribe narcotics, The Acadia Hospital has started a new program that teaches chronic pain sufferers drug-free ways to cope.

The eight-week program will help adults with persistent pain from injuries or illness to become more active and deal with the anxiety and depression that often accompany frequent pain. The therapy also has been proven to lessen patients’ reliance on prescription opioids, said Brent Scobie, director of research and planning at Acadia.

“Pain is not just a physical experience, but we don’t think of it that way,” he said.

Prescription painkillers can lead not only to addiction, but also to patients not living healthier, more fulfilling lives in the long term, Scobie said.

“Medical treatment of chronic pain can only do so much,” he said.

The Acadia program’s launch coincides with the development of new restrictions on opioids for residents covered by MaineCare, the state’s Medicaid program. As part of the supplemental budget process, lawmakers approved limits that include requiring MaineCare recipients with chronic pain to demonstrate that they have tried other pain therapies before they can receive their first prescription for opioids.

“Most doctors now understand that over the past decade people were put too quickly on these powerful medications and now they’re addicted,” said Gordon Smith, executive vice president of the Maine Medical Association.

Maine’s per-capita addiction rate for opioids is among the highest in the country. In 2011, opioids, such as methadone and oxycodone, were the number two substance Mainers sought treatment for, behind only alcohol.

Under the new regulations, set to take effect in January, MaineCare patients who are prescribed opioids for acute pain are limited to an initial 15-day supply. Two refills totaling 30 days will be allowed with prior approval from the Department of Health and Human Services, which oversees MaineCare.

If a doctor believes more than 45 days of opioids are needed, a second opinion from a physician outside the practice will be required for certain patients.

Some exceptions will be allowed for patients with HIV/AIDS and cancer, and those on hospice care. Patients recovering from surgery can receive two months of opioids before the new regulations kick in.

The regulations will affect about 60,000 MaineCare recipients now taking opioids, Smith said.

“This is considered to be standard practice,” he said.

Patients must abide by the new policies for MaineCare to cover the costs of their prescription painkillers, but can pay for their medications out-of-pocket without the restrictions.

People suffering from chronic pain, or pain lasting longer than three months, typically head to their doctor’s office for relief, Scobie said. But physical discomfort also can come with thoughts and feelings that heighten the perception of pain, which requires different treatment, he said.

Patients waiting for a diagnosis often get caught in a spiral of worry about the cause of their pain, while others may give up on activities they enjoy for fear of worsening their discomfort, Scobie said. Both problems can be alleviated through cognitive behavioral therapy, the basis of the new program, he said.

The therapy could be ideal for people who want to avoid taking narcotics or patients waiting for an appointment with a pain specialist, which can take up to a month, Scobie said.

“Chronic pain is already a tough thing to treat, especially in an outpatient office that’s extraordinarily busy,” he said.

The group therapy sessions will be held two times a day, at noon and in the early evening, beginning the last week of September. Acadia already is receiving referrals for the program and is scheduling initial consults, Scobie said.

While the hospital is seeking to work with local primary care doctors to refer patients to the program, those without a referral are encouraged to call Acadia, he said.

The program is not designed to treat substance abuse.

For more information, visit the hospital’s website at acadiahospital.org or call 1-800-640-1211.

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