Governor Signs Major Opioid Prescribing Reform Bill

In this photo taken on Feb 11, 2013, freshly dumped hypodermic syringes and a needle litter an abandoned cemetery in Myitkyina, the provincial capital of Kachin state, Myanmar. Myitkyina is known for having one of the highest concentrations of drug addicts in the world. The Kachin Baptist Convention, an evangelical group with over 300 churches in the state, says nearly 80 percent of ethnic Kachin youth are addicts. Their drug of choice is heroin. In the shadow of war, even drug abuse becomes politicized. Gryung Heang, the pastor of the camp church, says the government is willfully turning a blind eye to drug abuse among the Kachin because it wants to decimate young potential fighters. Officials say such views are absurd. (AP Photo/Gemunu Amarasinghe)

AUGUSTA – Governor Paul R. LePage on Tuesday signed into law LD 1646, “An Act To Prevent Opiate Abuse by Strengthening the Controlled Substances Prescription Monitoring Program.” The bill, introduced by the Governor, mandates prescriber participation in the Prescription Monitoring Program (PMP), sets limits for the strength and duration of opioid prescriptions and requires that prescribers submit opioid prescriptions electronically beginning next year and that they undergo addiction training every two years.

Approximately 75 percent of heroin addicts started with prescription opioid medications. Those being prescribed opioid pain medication are 40 times more likely to use heroin. Experts recognize opioid pain medications as a leading gateway to heroin use.

Governor LePage was motivated to introduce LD 1646 after meeting with the widow of a working man who was over-prescribed opiates following a workplace injury. He became addicted to the medication and eventually devolved into heroin use, which led to his untimely overdose death.

“Heroin addiction is devastating our communities,” said Governor LePage. “For many, it all started with the overprescribing of opioid pain medications. We can prevent many people from even trying heroin in the first place by putting these limits on the flow of pain pills into our homes. I am thankful to prescribers and pharmacists who helped to craft this legislation and ultimately support it before the Legislature. They recognize that the status quo hasn’t worked and it’s time for some serious reform.”

Referred to as an “aggressive move” by one national PMP expert, the new law makes Maine the third state in the nation to set a cap on the daily strength of opioid prescriptions. Maine’s 100 morphine milligram equivalent (MME) cap for new patients is slightly higher than the 90 MME called for under U.S. Centers for Disease Control (CDC) guidelines and lower than the 120 MME cap enacted by Massachusetts and Washington. Patients currently receiving opioid pain medication have a higher, 300 MME cap until July 2017 to ease their transition to a lower dose.

Both new and existing recipients of opioid pain medication may fall under one of several exceptions in the law to be introduced by Department of Health and Human Services (DHHS) rulemaking, such as those in hospice or palliative care, those suffering from pain associated with cancer, and more.

The new law caps scripts for acute pain at seven days and for chronic pain at 30 days beginning in January 2017 to prevent diversion and abuse. It requires the boards overseeing opioid prescribing health care professions to incorporate three hours of training on opioid addiction into the 40 hours of existing Continuing Medical Education coursework required by boards every two years. The new law requires prescribers to submit opioid and benzodiazepine scripts to pharmacies electronically by July 2017 in order to prevent diversion. Prescribers unable to comply with this requirement may seek a waiver from DHHS.

Under the law, opioid prescribers, including physicians, nurses, dentists, physical therapists and veterinarians are required to check the PMP—a statewide database of prescription information—prior to writing scripts for opioids or benzodiazepines that are to be filled and administered outside of a licensed health care facility. Currently, as few as seven percent of prescribers use the PMP. Dispensers, or pharmacists, will be required to check the PMP before prescribing to new patients, those from out of state, or those paying cash despite having insurance.

“This is a prevention bill and it is designed to get at one of the root causes of the heroin crisis in Maine,” said Dr. Christopher Pezzullo, Chief Health Officer for Maine DHHS and the leading clinician behind the bill. “This new law is in line with the latest clinical research, and it reflects the direction many prescribers are already heading in; it just sets new expectations to ensure prescribers are adjusting their practices to account for the tragic realities of opioid addiction. There are, however, ‘safety valves’ incorporated throughout this law to prevent unintended consequences.”

LD 1646 was sponsored by Assistant Senate Majority Leader Andre Cushing (R-Hampden) and received support from the Maine Medical Association, Maine Nurse Practitioner Association, Maine Osteopathic Association, Maine Employers’ Mutual Insurance Company (MEMIC), Maine Chiefs of Police Association, as well as many more.


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