December 14, 2017
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Maine doctors grapple with new limits on painkiller prescriptions

By Jackie Farwell, BDN Staff
Photo illustration by Eric Zelz | BDN
Photo illustration by Eric Zelz | BDN

As Gov. Paul LePage unveiled a plan Tuesday to expand addiction treatment across much of Maine, doctors readied for new prescribing restrictions designed to curb the state’s opiate abuse problem.

As of Jan. 1, 2017, clinicians prescribing opioid medications must first run the patient’s name through the state’s prescription monitoring program, which tracks transactions for addictive drugs. A chief goal of the database is to prevent “doctor shopping,” where patients visit multiple physicians to obtain numerous prescriptions for commonly abused drugs.

Clinicians who prescribe narcotics and other controlled drugs — including nurse practitioners and dentists, among others — are already required to register as users of the program. But now, they must actually check it before writing a prescription, a move officials at first avoided, due to complaints that such mandates intrude on the practice of medicine and burden time-strapped physicians.

In other states that have instituted such requirements, doctor shopping has dropped dramatically. New York adopted a similar policy in 2013, and saw doctor shopping fall a remarkable 75 percent, according to the Prescription Drug Monitoring Program Center of Excellence at Brandeis University.

The requirement affects all new and renewed prescriptions after Jan. 1, for both opioid medications and benzodiazepines, an addictive class of tranquilizers that opiate abusers often take to enhance their high.

Doctors are also gearing up for another requirement related to limits on how much opioid medication they can prescribe to patients. As of July, the law generally limits patients to the equivalent of 100 milligrams of morphine a day, unless they fall under an exception, such as cancer patients or those in end-of-life care.

Prescribers have been able to get around that requirement by noting on prescriptions that the medication is “medically necessary.” But that exception expires on Jan. 1, 2017.

A third requirement instituted under the law, also taking effect in the new year, limits opioid painkiller prescriptions to seven days for acute pain and 30 days for chronic pain.

While clinicians are expected to abide by the provisions come January, the state has agreed to hold off on enforcing them to give prescribers time to adjust to recent changes. One is the transition on Tuesday to a new vendor for the prescription monitoring database.

The other is a set of emergency rules the Maine Department of Health and Human Services plans to issue on Jan. 2, 2017, which will specify further exceptions to the law, such as allowing certain patients just out of surgery to exceed the opioid dosing limits.

In a Dec. 19 letter, DHHS agreed to wait until March 1, 2017, to notify professional medical boards of clinicians who aren’t in compliance with the law. Civil penalties will not be enforced until Oct. 1, 2017.

The delay will help prescribers to fully understand the law’s requirements, said Gordon Smith, executive vice president of the Maine Medical Association.

“The problem is not the law,” Smith said. “The problem is people’s misinterpretation of the law.”

 


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