The number of prescriptions filled in Maine for opioid painkillers is falling fast, at least partly in response to a law that took effect in 2016 aimed at reducing opiate abuse, addiction and overdose.
The reduced availability of the drugs is widely regarded as an essential response to the ongoing crisis of drug addiction and overdose deaths, but experts say it’s only part of the battle — and may even fuel a growing demand for deadly street drugs such as heroin and fentanyl.
According to data released on Thursday by the American Medical Association, the number of prescriptions filled nationally for addictive painkillers such as OxyContin and Vicodin has fallen by more than 22 percent since 2013, and by almost 9 percent between 2016 and 2017.
In Maine, the rate has fallen even faster, according to the data compiled by health information company, IQVIA. The number of filled prescriptions in the state dropped by 32 percent between 2013 and 2017— from 1,105,502 filled prescriptions to 752,128. From 2016 to 2017, the number decreased by more than 13 percent.
“This is something the medical community should be proud of,” said Gordon Smith, executive vice president of the Maine Medical Association. But, he cautioned, “this is just once piece of the problem, a piece that medicine owns.”
Smith credits legislation passed here in 2016 for the dramatic drop in opioid prescriptions, along with a longer-term campaign of physician education that came in response to the emerging epidemic. In 2017, that epidemic claimed the lives of 418 Maine people, many due to overdoses of heroin and the synthetic drug fentanyl, street drugs many users turn to when they can no longer find or afford prescriptions narcotics.
The 2016 prescribing law set in place a number of regulations, including limiting patients to a dose equivalent to 100 milligrams of morphine per day and capping prescriptions at seven days for acute pain and 30 days for chronic pain. It also requires prescribers to check Maine’s online prescribing database to make sure their patients aren’t “doctor shopping” — visiting multiple medical practices to obtain prescriptions for commonly abused drugs.
Filled prescriptions in Maine dropped more than 13 percent after those regulations took effect. Similar reductions were seen in some other states, with the greatest 2013-2017 reductions seen in West Virginia (37.6 percent), Rhode Island (33.6 percent), New Hampshire (33.2 percent), Maine (32 percent) and Ohio (30 percent), according to the AMA report.
Smith said it’s unclear which states have implemented regulations like Maine’s, but he thinks the law was key in reaching the significant drop here from 2016 to 2017.
“I don’t think we could have gotten there without these regulations,” he said.
Some doctors have chafed at the restrictions even when they agree with the goal, arguing that the rules interfere with their professional practice and burden their already busy schedules with additional layers of red tape. And plenty of patients have cried foul as well, including those who say their chronic pain can be managed only by higher doses of these powerful painkillers.
At the time the law took effect, some 13,000 Mainers were taking prescribed painkillers above the new, 100 milligram-per-day dose limit. Smith said some of those patients have been weaned to lower doses or off opioid drugs altogether, while others may have turned to illicit sources or heroin.
In an emailed statement, the Maine Department of Health and Human Services said the new law, along with the state’s existing prescription monitoring program, “has proven to be one of our strongest tools in combating the over prescribing of dangerous opioids.”
The statement noted that emerging literature shows that opioids may not be the most effective way to manage chronic pain. “By reigning in prescribing habits, not only are we able to wean patients off of these highly addictive substances, we’re also able to look at other pain management methods which may prove to be more effective in the long run.”
Smith said it’s important not to lose sight of other essential measures that must be taken in response to the crisis of addiction in Maine, including expanded access to treatment and recovery support as well as harm-reduction strategies such as the overdose-reversing drug Narcan and needle exchange programs.
A number of measures are pending funding and votes in the Legislature, Smith said, even as lawmakers prepare to adjourn for the year.
“The legacy of the 128th Legislature on opioid issues is really up for grabs in the next couple of weeks,” he said.
The Maine Drug Enforcement Agency did not respond on Thursday to a request for comment on the new report, but the Bangor Police Department warned of the unintended consequence of cutting the supply of prescription narcotics.
“If a person is dependent or addicted to an opiate drug that they need on a daily basis and that drug becomes harder to access by prescription, we do see people turning to illicit drugs like heroin,” said Sgt. Wade Betters of the Bangor Police Department.
Heroin and fentanyl are markedly cheaper and easier to find than prescription painkillers and other pharmaceuticals, he said, in part due to a seemingly limitless supply coming into Maine from out of state.
“That’s why we try to eliminate suppliers and dealers,” he said. “We’re not so much focused on the users. We don’t want the people who come here to profit from our addicted residents.”
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