Maine doctors seek exemptions to proposed opioid prescription limit

Posted March 17, 2016, at 6:44 a.m.
Last modified March 17, 2016, at 8:02 a.m.

The state of Maine could set its own prescribing limits on opioids if lawmakers approve a pair of bills presented to the Health and Human Services Committee on Wednesday.

One bill, backed by Gov. Paul LePage, would set strict criteria for how much and how often clinicians can prescribe the painkillers.

Another bill from Sen. Roger Katz, R-Augusta, directs medical licensing boards to establish prescribing limits. The bills come after this week’s first-ever release of guidelines by the U.S. Centers for Disease Control and Prevention on prescribing opioids.

LePage wants bold action to make a difference in the opioid abuse crisis, according to his senior policy adviser David Sorensen. His bill delivers, Sorensen said, by reducing unnecessary opioid prescriptions.

“This bill caps prescriptions at 100 morphine milligrams a day,” Sorensen said.

Compare that to the new CDC guidelines, Sorensen said, which caution against prescriptions that exceed 90 morphine milligrams per day. He said other provisions of the governor’s bill also are in line with the CDC recommendations.

“The bill limits scripts to three days for acute pain and 15 days for chronic pain. They recommend three to seven days for acute pain,” Sorensen said.

The bill also requires clinicians to undergo training for prescribing opioids and to check patient information in the state’s Prescription Drug Monitoring Program when ordering prescriptions.

Attorney General Janet Mills told committee members she doesn’t always agree with the governor, but she supports this bill because Maine can’t afford not to take action.

“Out of the 272 individuals who died last year from drug overdoses, 111 of those died primarily due to prescription drugs,” Mills said.

The governor’s bill drew general support in the public hearing for its efforts to reduce opioid abuse. However, certain provisions, such as the prescribing limits, drew concern. Gordon Smith of the Maine Medical Association likened the governor’s proposed caps to a blunt instrument in the treatment of patients who have individual needs and by doctors who must make nuanced decisions.

“What they objected to most strongly, and we’ve heard from hundreds, is when you get in the examination room with your limit — the average daily dose limit — and stand between them and their patient, what they think is needed for their patient to continue their care. They really bristle at that,” Smith said.

Others, such as Hilary Schneider of the American Cancer Society, said the governor’s bill should provide exemptions on prescribing limits for certain patients.

“According to the National Cancer Institute, use of opioids for the relief of moderate to severe cancer pain is considered necessary for most patients,” Schneider said.

Dr. Elizabeth Hart points out that some hospice and palliative care patients also legitimately benefit from high doses of opioid painkillers.

“I don’t think this is just end-of-life pain. People can receive palliative care for many years, even while pursuing curative treatment, and they may require escalating higher and higher chronic opioid doses,” Hart said.

Hart, along with the Maine Medical Association, told the Health and Human Services Committee they prefer Katz’s bill, which would direct licensing boards to develop appropriate opioid prescribing standards for clinicians. They did say they could support the governor’s bill if it is amended to loosen the prescribing caps and to provide some exceptions. The CDC guidelines do include exemptions for cancer, palliative and end-of-life care.

This article appears through a media partnership with Maine Public Broadcasting Network.

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