Essential to the agreement was the extension of the 3-day limit for acute pain and the 15-day limit for chronic pain proposed in the Governor's bill, L.D. 1646. The agreement provides for a 7-day limit for acute pain and a 30-day limit for chronic pain. The seven day limit will mirror the law passed in MA last week. These limits will apply only to opioid based medication prescribed for pain, not for medication prescribed for addiction treatment. In addition, exceptions are being developed for cancer pain, end of life care, hospice care, palliative care, and medication administered in some institutional settings with additional exceptions to be developed through rule-making by DHHS. 

Perhaps the most difficult part of the agreement is the retention in the bill of the limit on an average daily dosage of opioid medication to 100 morphine milligram equivalents (again, subject to the exceptions above).  While this limit exceeds the CDC guidelines announced last week, there are thousands of patients who currently exceed that threshold. Under the agreement, the only exception option for patients who can not be tapered who are not in an exception category is to seek relief through the rule-making process by adding to the exceptions. 

The mandatory education requirement in the Governor's bill will be changed to simply require that three hours of the existing 40 hours of category one CME credits by committed to the topic of prescribing for pain for those physicians who are prescribing opioid medication. All the licensing boards regulating prescribers of controlled substances will be directed to amend their continuing education rules to implement this mandate.

The amended bill will continue to require a check of the Prescription Monitoring Program (PMP) each time a new opioid or benzodiazepine script is written and every 90 days thereafter if the scripts continue to be written.

The requirement to electronically transmit opioid scripts to a pharmacy is retained in the agreement with an effective date of July 1, 2017. If it is not possible for prescribers and pharmacies to implement this requirement by that date, an extension of the effective date or waivers could be considered. Only the state of New York currently has such a requirement.

Several provisions in L.D. 1648 sponsored by Senator Roger Katz (R-Kennebec) appear to have the support of the majority of the HHS committee and are likely to be grafted on to the Governor's bill. These provisions include some enhancements to the PMP and a requirement that pharmacists register to be data requesters, as prescribers are required to do.

MMA believes that in the current political environment with substantial concern about the opioid abuse epidemic among Maine policymakers, legislation in keeping with the agreement described in this article and the memo mentioned above is almost certainly going to pass this session.  MMA recognizes that members will have varying views on the elements of this agreement and we encourage you to communicate your views on the opioid abuse epidemic to key legislators.  Because the bills remain in work session status in the Joint Standing Committee on Health & Human Services, we urge you to contact members of that committee now.  You can find the HHS Committee members and their contact information here.  It also would be valuable to communicate with your own Representative and Senator and, if you don't know your members, you can find each and their contact information here.

Questions about the agreement should be directed to any of MMA's advocacy team of Gordon Smith, Esq., Andrew MacLean, Esq., and Peter Michaud, J.D., RN.  They can be reached by calling the office at 622-3374.