The Maine Medical Association is involved with several programs that address Maine's Opioid Crisis and provide resources and information for Maine clinicians.
Overdose Detection Mapping Application Program (ODMAP)
MMA-CQI is working on the implementation and use of the ODMAP tool. ODMAP is a web based reporting tool developed by the High Intensity Drug Trafficking Area (HIDTA) program of the Drug Enforcement Agency (DEA).
MMA CQI is assisting to set up and activate a comprehensive communication protocol. This protocol shall help systematize and automate a cascade of communication activities and resource mobilization to reach elected officials and other public officials, law enforcement officers, EMS providers, community members, health care providers, harm reduction partners, and others when an overdose spike occurs. To learn more about ODMAP go to Overdose Detection Mapping Application Program (odmap.org).
Overdose Prevention Through Intensive Outreach Naloxone & Safety (OPTIONS)
OPTIONS program provides an SUD clinical liaison that is embedded within a First Responder Agency. The program is to connect individuals with linkage to care within their community. MMA-CQI is working with the Office of Behavioral Health (OBH) for the technical assistance portion of the program. Areas of focus are program policy, procedures, MOUs, ODMAP data entry, leave behind care pacakages, workflow processes, and operationalize county co-responds. To learn more about OPTIONS go to Options Learn How To Save A LIfe (knowyouroptions.me).
Overdose Data 2 Action Connecticut (OD2A CT)
The OD2A program consists of 5 components:
- Workforce Development: trainings and team meetings for current and new health department staff and other key stakeholders to advance substance and opioid misuse knowledge
- Data Collection and Dissemination
- Community Communication Campaigns: release of information to the general public on substance and opioid misuse, naloxone and MAT
- Prevention: participation in community task force/coalition for determining priority, assessing data, and initiating prevention programs
- Response: initiate programs for community stakeholders that address high burdened areas and high risk populations.
The MMA-CQI has partnered with the Milford Health Department on this initiative.
Medication Assisted Treatment in the Emergency Department (MAT in the ED)
MMA-CQI is working under a contract with the State of Maine to relaunch an education program for interested hospital Emergency Departments (EDs) focusing on how to initiate buprenorphine in the ED. During the Rapid Induction Starting in the ED (RISE) project, MMA-CQI is offering virtual training events and one-on-one sessions to provide education and assistance on best practices for initiating buprenorphine in hospital EDs for individuals with Substance Use Disorder (SUD) who are looking to engage in treatment during an ED visit.
BOLIM Funded Learning Management System Modules
Over the course of several years, the Maine Board of Licensure in Medicine has provided funding for the development of online learning modules that clinicans can access on demand. Twelve of the developed modules focus on opioid and substance use related topics such as Safe Prescribing and Alternative Treatments to Pain. The learning modules can be accessed at www.qclearninglab.org.
Maternal Naloxone (MMET)
The Perinatal Quality Collaborative for Maine (PQC4ME hosted by MMA-CQI) demonstration project will pilot the effects of universal harm reduction education to Obstetrical staff and providers at Franklin Memorial Hospital and access to a home first aid kit including naloxone to all postpartum persons with the goal of reducing postpartum opioid overdose-related maternal mortality.
The goal is to reduce overdose-related deaths in the postpartum period by:
- Educating hospital staff and providers on harm reduction, effects of substance use stigma, and overdose prevention
- Offering naloxone as part of a home first aid kit
- Improving coordination of community recovery resources with hospital-based services through linkages of these services.
Maine Independent Clinical Information Service (MICIS) Academic Detailing Sessions
Topics for Opioid Prescribers
Academic Detailing is peer-to-peer educational outreach designed to improve prescribing practices. It is useful for improving quality of care and identifying priorities for change. The Maine Independent Clinical Information Service (MICIS) offers individual one-on-one sessions with a MICIS Academic Detailer. Maine prescribers of opioids (physicians, nurse practitioners and physician assistants) may request a free 1-hour session to be scheduled for any time of day. Current topics are: Opioid Prescribing Discussion including Maine law; MAT (Medications for Addiction Treatment) Basics Discussion; MAT (Medications for Addicition Treatment) Advanced Discussion, and Deprescribing Opioids and Benzodiazepines.
MICIS also is offering a 1-hour presentation "Prescribing to Reduce Opioid Overdose Risk: How to impact the epidemic within the pandemic" which can be scheduled at medical practices, hospitals and health care conferences. MICIS is a program of the Maine Medical Association and has provided evidence-based prescribing education since 2008. www.micismaine.org.
Documents on the opioid crisis:
MMA Comments to Licensing Board’s on Applicability of Chapter 21 Opioid Rules to Long Term Care Setting (5/31/18).
Attorney General Janet Mills Releases 2017 Maine State Drug Death Statistics (2/22/18). Full Report is also available.
Opioid Health Home Report (from DHHS to the HHS Committee - Jan 2018)
MMA's summary fact sheet on the opioid law and rules (6/15/18)
- Maine Legislature's Opioid Task Force Report
Maine people are keenly aware of a major epidemic that killed 272 Mainers in 2015: the opioid addiction epidemic. Many groups and individuals, significantly including the Maine Medical Association, are taking steps to address this crisis. Legislation has been passed to address various parts of the problem:
- Public Law chapter 378 (LD 1537): new drug enforcement agents, treatment and prevention/harm reduction efforts
- PL c. 351 (LD 140) and c. 508 (LD 1547): increased access to naloxone to prevent overdose deaths
- PL c. 507 (LD 1552): syringe exchanges
- PL c. 488 (LD 1646): limits on amounts and timing of opioids prescribed; mandatory checks of the Prescription Monitoring Program; Opioid CME requirement (PowerPoint explanation)
- DHHS 2017 (1/1/17) Rule on opioid prescribing and use of the PMP 14-118 C.M.R. Chapter 11 NOTE: This form of the rule is no longer in effect. It has been superseded by the rule as stated in the next item
- DHHS Rule (3/31/17) on opioid prescribing and use of the PMP 14-118 C.M.R. Chapter 11
- MMA Comments on the DHHS Opioide Rule (2017)
- MMA's Question & Answer document on chapter 488 (2016)
- Maine Prescription Monitoring Program (PMP) website
- MMA Comments on Proposed Rule RE: Chapter 21, Use of Controlled Substances for Treatment of Pain
New Documents Posted by DHHS (June & July, 2017):
The various prescribers' licensing boards (Medicine, Osteopathy, Nursing, etc.) have a joint rule on the use of opioids, called Chapter 21. It can be found by going to a board website, such as http://www.maine.gov/md/laws-statutes/rules-statutes.html, and clickiing on Rules Chapter 21. That rule is currently undergoing revision, but the version in the link is currently applicable.
Gordon Smith, Esq., Executive Director of the MMA, wrote a letter to the Association membership explaining chapter 488.
In early 2016, the U.S. Attorney for Maine, the Maine Attorney General, and the Maine Commissioner of Public Safety (known collectively as the Maine Opiate Collaborative) created three task forces to study various aspects of the opioid addiction problem. On May 6, 2016 those task forces issued their reports, which include significant recommendations for dealing with the problem:
- Law Enforcement Task Force Report
- Treatment Task Force Report
- Prevention & Harm Reduction Task Force Report
- Summary of Recommendations
Education of the prescriber community, including physicians, nurse practitioners, dentists, podiatrists and even veterinarians, began well before this was big news in the press. The MMA has presented Continuing Medical Education (CME) programs on the topic. The Maine Independent Clinical Information Service (MICIS), an arm of the MMA, has been delivering free clinical education on opioids and naloxone to Maine’s physicians and nurse practitioners.
As time goes on, and as more initiatives are put into place, we will be updating this page to keep you connected with the resources that medicine is bringing to bear on this problem. As with many other epidemics, this is a serious public health challenge that the medical community and many others are working to solve.
Other useful links:
U.S. CDC Guidelines on Opioid Prescribing
Maine Voices: Steps Maine Can Take to FIght Addiction - Op Ed piece by Brian Pierce, MD, MMA President, Published in 1/10/16 Maine Sunday Telegram
AMA President Steven J. Stack, MD: Confronting a Crisis: An Open Letter to America’s Physicians On the Opioid Epidemic
Helpful Links Provided by the American Society of Anesthesiologists: