- The Maine Wire - https://www.themainewire.com -

Maine needs to address its medication management crisis

Rural states, including Maine, are facing an impending health care crisis: we are running out of health professionals who can prescribe, monitor reactions to and adjust medications. 

Part of the problem is that medical professionals are distributed unevenly and in short supply for those who are at the greatest risk for health problems in rural states like ours. 

And unfortunately, doctors, physicians’ assistants and nurse practitioners––those who often provide medication management services––are for the most part older.

Because health professionals are already unevenly dispersed throughout our state, and because those who can provide medication management services are moving into retirement, our state is at serious risk of having few medication managers in the near future.

When sick people have to wait extended periods of time for visits with medication providers, they take more unnecessary trips to the emergency department in an attempt to get their medication management needs met. These emergency room visits overburden hospital staff and cost taxpayers more money.

The medication management shortage is especially problematic for mentally ill populations. Psychiatric patients in particular are more likely to use emergency room services than other groups of people, and they also stay in emergency rooms for longer periods of time. 

Imagine if you or a loved one were suffering with some form of mental illness––depression, or maybe something that is often more debilitating, like schizophrenia or bipolar disorder––and you had to wait for months to receive your medication. 

The concerning reality is that it often can take months for those suffering from psychiatric illnesses to visit with a health professional who prescribes psychiatric medication. 

Fortunately, there’s a partial solution to the problem. Maine could allow medication providers from other states to monitor psychiatric medication via telehealth services. 

Governor Janet Mills has already taken some action in this regard––she signed an executive order in March allowing telehealth providers from other states to practice within Maine. The order allows telehealth providers to prescribe medications after a video consultation, rather than requiring an initial in-person visit before prescribing. 

The executive order was passed for the obvious reason that it would limit visits to hospitals and doctors’ offices during the COVID-19 crisis. But allowing physicians in other states to prescribe via telehealth also addresses the troubling prescriber shortage in Maine. 

An influx of out-of-state medication providers would increase the total amount of providers in our state, thereby meeting our demand for rural prescribers. 

In the long-term, it is not possible for Maine to allow scheduled medication prescription exclusively via telehealth in-state or out-of-state until the federally-instituted Ryan Haight Act (a federal law that prevents schedule II-IV drugs from being prescribed without an initial, face-to-face visit with a medication prescriber) is amended or repealed. 

Although the Ryan Haight Act impedes those in rural areas from accessing medication easily, removing Maine’s out-of-state practitioner restrictions for telehealth would still drastically improve medication accessibility for patients and increase the amount of medication providers that Mainers can see.

For example, if the Maine Legislature were to amend current telehealth legislation to permanently allow health professionals from other states to practice in Maine via telehealth, a patient from Maine could visit a medication manager in Massachusetts, New Hampshire or Vermont who specializes in psychiatric medication for an initial visit, get an initial prescription, and then see that medication manager for follow-up visits and medication adjustments via telehealth for several years without any additional face-to-face contact.  

Letting health providers from other states practice in Maine would not be a bold step into uncharted territory. After successfully relaxing telehealth restrictions over the last few months, Idaho has chosen to permanently allow physicians from elsewhere to practice in their state. 

Telehealth psychiatric care has been effective for the duration of the COVID-19 crisis, and we should work to ensure that as many telehealth providers as possible are available to Mainers. 

Maine lawmakers should specifically support revising the section of law that mandates practitioner and prescribing regulations. Lawmakers could alter this chapter of law to give out-of-state medication managers permission to independently prescribe scheduled medications after an initial visit. At the moment, medication managers from other states can only act as consultants for doctors who are licensed in the state of Maine. 

Relaxing laws by allowing out-of-state providers to prescribe in Maine would not fully resolve our medication management dilemma, but it would be a start toward increasing medication access for some of the most vulnerable members of our population.