L.D. 1646, An Act to Prevent Opiate Abuse by Strengthening the Controlled Substances Prescription Monitoring Program, Passes Committee

L.D. 1646, An Act to Prevent Opiate Abuse by Strengthening the Controlled Substances Prescription Monitoring Program, Passes Committee

Created on: Friday, March 25, 2016
Author: Maine Medical Association

Re:      L.D. 1646, An Act to Prevent Opiate Abuse by Strengthening the Controlled Substances Prescription Monitoring Program

For the past two weeks, the Maine Medical Association has been working with legislators and the LePage Administration to develop legislation responding to the current opioid/heroin crisis. We have tried to do this in a way that recognizes the legitimate interests of pain patients and the professional interests of physicians and other prescribers. We solicited the input of as many members as we could reach, through a membership survey and via our Maine Medicine Weekly Update and weekly Legislative Committee calls. The MMA Legislative Committee, chaired by Amy Madden, M.D., worked diligently to consider the many diverse opinions and reached out to other organizations for input as well. On March 17th, MMA representatives reached agreement with LePage Administration officials regarding amendments to L.D. 1646, an agreement which MMA leaders believed represented a reasonable compromise. In two subsequent work sessions, our amendments were accepted and more were developed which continued to improve the bill. On March 23rd, the Joint Standing Committee on Health & Human Services voted 11 to 1 “Ought to Pass as amended” on L.D. 1646 and the bill will go to the floor of the House and Senate in early April. Senate Chair Eric Brakey (R-Androscoggin), the sole dissenting vote, recommends that the bill “ought not to pass.”

As the amended bill does impose limits on prescriptions for opioid medication and mandates use of the Prescription Monitoring Program (PMP) for new scripts for opioids and benzodiazepines and every 90 days thereafter, we recognize that some members may be disappointed that we would support legislation that both interferes with professional judgment and imposes administrative barriers to some aspects of practice for those physicians prescribing opioid medication. Other members have expressed the opinion that the legislation is long overdue and that more needs to be done to respond to the current crisis – a crisis that in 2015 resulted in 272 overdose deaths, 1013 babies born with indications of neonatal abstinence syndrome, and 18,000 criminal drug cases being filed in Maine Courts - all significant increases from the previous year. Following careful deliberation and consideration of the many responses we have received to the member survey, we believed that MMA should support the legislation so long as some essential amendments could be achieved. We are proud of the work of our advocacy team in securing these amendments which resulted in the following changes to the Governor’s original proposal.

1.     The limit on opioid scripts to 3 days for acute pain and 15 days for chronic pain were expanded to 7 days and 30 days respectively.  There is no prohibition on renewing these scripts for as long as the physician believes the medication is medically necessary.
2.    The effective date of the durational limit on scripts was extended to January 1, 2017.
3.    The effective date of the mandated PMP check for initial opioid and benzodiazepine scripts was also extended to January 1, 2017
4.    The 100 milligram limit (morphine milligram equivalent) average daily dose was amended to allow patients in excess of the limit currently to have a 300 MME limit until July 1, 2017. By that time, additional exceptions will have been developed by DHHS.
5.    Although the 100 MME limit for new scripts will apply 90 days after the session adjourns, this limit can be overridden by documentation of medical necessity (this provision will sunset once the DHHS rule-making is complete). We extend our appreciation to our colleagues in the hospital world for achieving this important medical necessity exception.
6.    The requirement of prescriber education was folded into the existing CME system. Three hours of the current forty hours of CME every two years must address the general topic of pain management and prevention of diversion and addiction. The three hours may be reduced in the future.
7.    Very importantly, we were able to achieve exceptions from the application of all the provisions of this law (mandatory PMP checks, dosage limits, and durational limits) for patients with cancer, patients receiving hospice care, end-of-life care or palliative care, patients receiving medication assisted therapy (MAT), and patients having medication administered by health professionals in hospitals and nursing homes. Additional exceptions will be developed by rules promulgated by DHHS by January 1, 2017.

Additional amendments achieved through the efforts of the Maine Hospital Association, MaineHealth, Eastern Maine Healthcare System, and other interested parties included the ability to provide information to DHHS to gain more time to comply with the requirement of electronic prescribing which is effective July 1, 2017. This deadline also could be extended through action of the 128th Legislature.

Anticipating that legislation of this nature would be presented, MMA worked with Senator Roger Katz (R-Kennebec) to develop an alternative proposal, L.D. 1648, which covered some of the same ground but directed the medical licensing boards to set the standards through amendments to existing Joint Rule Chapter 21, Use of Controlled Substances for Treatment of Pain. While we were unsuccessful in convincing the LePage Administration of the merits of this approach, some of the provisions in the Katz bill have been added to the Governor’s bill, such as a requirement for more sharing of data between states and Canada and a requirement that pharmacists also register and use the PMP as prescribers are required to do.

Other positive provisions in the final draft include:
1.    Prescriber immunity from liability for disclosure of information to the PMP.
2.    The ability of a patient to request a partial fill of a prescription.
3.    Improvements to the PMP included in unallocated language.

Following passage of the bill and well before the effective date of any of the provisions, MMA attorneys will prepare additional information including “Frequently Asked Questions” and place these documents on the MMA website.  They will also be available for educational presentations. 

As legislation such as L.D. 1646 is considered, and including the applicable rules to be developed, it is critically important that we are able to communicate with our members. Recently we sent out a member survey by Email. If you did not receive the survey allowing you to provide your opinion on these issues, it is either because you have not provided an e-mail address to MMA or we could not penetrate the filters on your work e-mail.  The new data form being sent by Email and USPS mail (and available on the MMA Website) is designed to give you a variety of ways to communicate with us, including through social media. We can’t stress enough how important it is for us to maintain an up-to-date database if we are to represent our members' interests effectively at the State House and in the Executive branch regulatory agencies.

You are invited to comment below. This is just another way the MMA is working to listen to our members and best represent your interests.

Visitor Comments

Travis Harriman (Thursday, May 04, 2017)

An act to prevent opioids abuse

I have a condition called small fiber neuropathy where the nerves in my feet and legs are damaged.It took doctors 12yrs. to find out what was wrong with me.I have tried everything,including acupuncture,spinal cord stimulator and morphine pump.The pump was working until it got infected and gave me spinal meningitis.After having it taken out I had to go back on opioids.When I went on opioids I had to start out 10yrs. ago at a higher level than the limit they are putting on.So I am asking how are people with chronic pain supposed to live?With this new law we are either going to be in pain or are going through withdrawals for the rest of our lives.How would these politicians like to live like that?I would rather have a shorter life that was fairly normal than to live like they are forcing us to right now.I will not live like that.I will have to move to another state,which is hard to afford on disability,or have to do something more drastic.

Paul G (Monday, March 20, 2017)

L.D. 1646

There really needs to be exceptions for people with diseases, My wife has MS and takes pain meds because she has lesions on her trigeminal nerve that causes her sever facial pain and ear and eye pain the same pain as Trigeminal neuralgia sufferers. If she is not allowed to continue to take the only thing that works for her I\'m afraid she may commit suicide. I don\'t know what to do.

David J Fisher (Thursday, March 09, 2017)

LD 1646 an act 2 prevent opiate abuse

I like everyone else including the DR\'s am very confused about the actual rules 4 the dispensing of opiates after July 2017. My script says take 1 ten mil. oxycodone twice a day of which I take 45 pills every 5 months even though I am in pain all the time I try to take them as little as possible. I have degenerative disc, osteoarthritis on both knees, permanent partial disability thru workers comp.on my ankle from a dislocation, ostiopinna since 2000 from being on perdnisone 4 escemic collites, chronic sciatica from the foot dislocation & otsioarthritus in my lower back. Are the new rules going 2 affect my prescription & use of the pain meds.

Jerry (Monday, February 06, 2017)

Heroen epidemic caused by Governor himself

I am a cronic pains sufferer have been since 2010 when an accident most of the right side of my boidy either broken or sereverely torn up to the point that waking up on a pain level of 8 on a 1 to 10 scale i a good day. For two yersi was basicly bed ridden as ny movement hurt so much. I tried every type of medication mand rherapy known to help,with no success. My Doctor in my eyes is the best as not only does he listen very carefully but he discusses every aspect with me.I had NO quality of liffe what so ever,Then I tried oxycodone and shortly after not only was I moving but I was enjoying life once again,and at 47 years old that alone meant so much. Now the great Governor of our State took Oxycodone off the Maine Care list which forced all those others like myself to find something that returned quality of life back ro them.So they saught the onlyu solution known replacethe oxy with heroin. Well of course the deslerd csaught thid whirlwind and upped the supply for the demand. Then as the deslers found that they could \"cut\" their product and make even bigger profit up went the death toll..If the great Governor could only puush himself away from trhe supper table as easy as he removes the quality of life from the peopleofMaine and clsose the market of heroin in Maine everyone wil be lealthier, Thiink about it by making this new law only opens a bigger door the for the heroin dealers and kill more people who otherwise would never of tried it had the Governor left the Oxycodoe alone. Grante theGovernor shows he is a gret eattter but a lousy doctor and useer of common sence

My name is Robin, (Saturday, December 24, 2016)

Bone with exploding joint pain

l could not believe when I heard what LePage was planning. My whole life fell apart. My disabled child who I love more than life and cared for over 30 years is now in a cold Facility thanks to LePage. For 17 years I have been on a 100.mg. Fentanyl patch. I was on a much higher dose in 20007. On my own, I found a pain specialist and had him very slowly cut me back as much as I can stand. It took him about a year to get me from 375 mg. to 100mg. I felt some pain at this point but he wanted to try for 95 mg every two days. Of course it was the weekend and he could not be reached. I was exploding with the worst throbbing pulsating pain from head to feet. I was screaming, praying to God to help me when I remembered that I had a 5mg patch left over from a time when he was cutting me back. I put it on and it took hours for that patch and 6 Advil to even start to kick in. Crying rocking back and forth and praying that I never feel like that again. 9 years later I have been able to live on 100 mg. Every 2 days and yes always have some pain especially rainy days and winter months. For the past 2 years I have asked my doctor to please give me something for days when I suffer so much I can\'t do anything but cry. She wanted to give me more Fentanly. I said please no more Fentanly. I have done so good for so many years not to go down that road again. With her it was that or nothing. My cry\'s fell on death ears so I have been taking Advil with Gloucosamie but has done nothing but give a huge stomach problem. Now finding out that our meds will be decreased has thrown me into a panic , I want to thank you LePage for being responsible for me putting my child in a facility. I also feel I have no choice but to take my life. I can\'t and no one could live with that kind of pain.impossible! My pain is so off the charts the doctors don\'t even know how to rate my pain. Even on my meds, doctors don\'t know how I could smile everyday. I told them because my daughter Dannie Rose needs to see a happy mom so I try to stay happy for her. Now my friends mother 82 loves cooking, always people around laughing full house of love and she\'s always on the go. Her doctor took her meds back a few month\'s ago. How sad, every time I go to visit her she don\'t want to see anyone. The house is cold and empty and she stays in bed curled up in a ball with so much pain she only wants to die. I want to know where LePage got his damn medical license to sit there and judge how much people need for pain meds. He is killing people!, that poor old gal shouldn\'t need to spend what few years she had left in bed in a ball crying her eyes out in agony. You can sure bet if he was a cancer victim and his nerve endings were fried due to Chemo, he would be taking the what meds he needed to continue his life. I\'m sure he wouldn\'t curl up in a ball wasting away or blowing his brains out. There cutting my meds back on the first of January and there is no way I can live with this kind of pain and my doctor won\'t bat for anyone because all she cares about is her license and told me as much. I feel alone. My child is being looked after so I was able to see to that. I need to find a home for my sweet Chihuahua. After 1-1-200017 is all LePage\'s FAULT!!! rn

Justin (Thursday, November 24, 2016)


At the age of 36 years old I have been on pain medications for over 16 years now due to complications caused by my diabetes. I have neuropathy in almost my whole body constant shocks and pains. I have had both of my legs amputated below the knee which also causes really sever phantom pain. I am a proud husband and father of 3 children and actually serve as a stay at home dad. At the time that I was made aware of this new law my provider informed me that I was at 1,300 mg morphine equivalency and would be cut back to 100mg a day by mid 2017. I understand that the state of Maine has an opioid epidemic however these strict rules are going to hurt a lot of people that have done nothing wrong. Although the dose I take is very high I still after many many years continue to live a good life ( six years longer then expected when I was in my mid 20\'s due to all the complications from the diabetes) I have a very active role in all my kids lives and considering loosing both legs still function very well just with a lot of pain. I have tried many many other treatments for pain not only here in maine but when I lived in Texas for about 5 years. For me the pain meds work, I have never had any problems controlling my meds and have followed a strict regiment that works well for myself. I fear that having my meds cut back to this minimum limit will make life almost impossible to function in. I ask that you take my case and many others like mine into careful consideration when developing the new guide lines for who will be exempt from this new law and I\'m very willing to answer any question that you may have in the future. Thank you, Justin

Frederick (Tuesday, November 15, 2016)

L.D. 1646

I have been managing clinical anxiety for over a decade. The combination of holistic, cognitive and drug therapy have been vital in managing this anxiety in a responsible and effective manner. The Prescription Monitoring Program that directly affects my access to benzodiazepine based pharmaceuticals is overreaching for me and I suspect for many others. rnrnIn some sense, I feel like I\'m a junky when I have to make an appointment with my doctor to continue the use of a rarely consumed, but necessary drug. It\'s humiliating quite honestly.

Kathleen s Billis (Wednesday, November 09, 2016)


I have had rheumatoid arthritis since I was 15. I am now 70.for the last 25 yrs I have been on a high dose by regular standards; but with pain medicine ( OxyContin 325 mg 4-5 a day) I have been able to live a wonderful life as a plein air artist traveling all over the world enjoying a career with several galleries carrying my work. I have been taking the same amount for at least 20 years. There is a difference between being addicted and being habituated to a certain amount that works for me. My doctor has strict monitoring practices. As my sed rate is normal I am not treating ACTIVE disease BUT THE EXCRUCIATING PAIN of having a body of damaged joints from multiple surgeries as well the disease itself. I have worked so hard to keep my life--my work, family;and I am terrified that MY LIFE as I have known it will be taken away by a well intended but ill informed law about treating chronic long sometimes life long pain. Because of my age I have been subjected to so many types of treatment , some more dangerous than my disease. There is NO discussion about using biologicals or drugs tat are equivalent to chemo drugs. People die from complications of those drugs more than the public is told. Please don\'t let laws come between patient and Doctor to make exceptions for patients like myself to carry on with their lives. As so many people have said, lawmakers don\'t necessarily have any idea how chronic pain can destroy a career, family, marriage.

mike locke (Wednesday, September 07, 2016)

to people making new laws when not living in pain

I Ben on 90 mg morpine er 3xday and 30 mg of oxy 3xday for 10 yrs I have osteogenesis imperfecta tipe 3 I\'ve broken my bones over a 100 times in my life from my neck to back arms legs I all so have severe scoliosis have rods in both legs from my hip to my feet and screws in my hips and they are making a new laws that is going to cut my pain meds down to next to nothing 100 mg of morphine a day the people making the new laws Im shore are not living in pain and do not cry them self to sleep begging for the pain to go away so they can sleep just two hrs what in trying to say just because some people want to get high and kill them selfs why do people that can\'t get out of bed and live a life have to have there lifelihood taking away I can\'t get out of bed or even sit up in my wheelchair with out my meds all the new laws are going to do is make people go to the streets to get pain relief its just going to be more overdoses more people in prison .more suicides because a lot of people won\'t turn to the streets I bet my life on it these new lawmakers are not living with severe chronic pain because if they were they would not be passing these laws I get where they\'re coming from make the ones that are breaking the law make them more strict more severe bigger punishment don\'t punish the ones doing nothing wrong that were in an accident or born with something that did not ask for please take this into consideration sincerely a chronic pain patient

Peter Michaud, MMA (Wednesday, July 06, 2016)

LD 1646 (Public Law c.488)

Sheila, as a patient you should speak directly with your prescribers about these issues. If they have questions about what is legal, they should consult their employer. If you as an employee have similar questions, you should talk to your supervisor. The Maine Medical Association is not in a position to tell medical providers whether they are right or wrong.

SHEILA PARKER (Wednesday, July 06, 2016)

wrong information law LD1646


Peter Michaud, MMA (Thursday, June 23, 2016)

LD 1646 (Public Law c.488)

Jennifer, you may want to suggest that your NP contact her professional association. Prescriptions for chronic pain are limited to 30 days EACH, but the law does not limit the number of prescriptions that may be written. Therefore a person may get successive prescriptions for 30 days at a time, and there is no limit in the bill to the total duration of prescriptions.rnrnThe exceptions are to the amount of medication, not to the time limits.

Jennifer (Thursday, June 23, 2016)


Now that I read this I am very confused on what my nurse pracitioner just told me. She told me that at our practice all chronic pain patients are being completely weaned off of pain medications before January 1 2017. this she stated is as a result of this bill. Seh stated that it was because this bill was limiting perscribers to seven days of medication for acute pain and thirty days for chronic pain. But I also see that this says that this is allowed for as long as the provider sees medically necessary. I am very afraid of this bill because I have endometriosis interctiscial cystitis chronic pelvic pain chronic low back pain. I have been told by a pain management specialist that narcotics are my only option.

Peter Michaud, MMA (Thursday, May 26, 2016)


All of those points were raised and discussed by the Legislature's Health and Human Services Committee, which was charged with reviewing the bill and voted it "Ought to Pass" before sending it to the full House and Senate. The Maine Department of Health and Human Services will be making rules that deal with, among other things, exceptions to the limits. We encourage you to find out when those rules will be presented for public comment and to make your voice heard. You can check http://maine.gov/dhhs/dlrs/rulemaking/proposed.shtml to find out when the proposed rules will be ready for review.

Sun Shine (Monday, May 23, 2016)


If you have had chronic pain for years due to back problems and nerve damage due to unknown reasons and have been on high doses of pain meds for a few years and it has been helping when no other therapy has, would there be any exceptions for this person to continue their current pain medication regimen at the current high dose indefinitely? There definitely should be exceptions for pain management patients like this one or you may find the heroin use go up, way before it goes down, from patients like these in search of pain relief on their own. Some people, there is no medically \"fixing\" them to stop the pain. There is then only pain management. Without pain management, you have people trying all kinds of things to manage their pain on their own. 100mg of morphine really isn\'t much to someone who has chronic severe pain. They are usually on at least double the dose for pain control. Also, those that have chronic severe pain currently stabilized on a high dose of pain meds with full time jobs will likely have to cut back their hours or quit their jobs due to the severe, not managed, pain. That means more people homeless or living off the State, increase in Mainecare, increase in snaps, and tanf. Which all leads to increased depression due to un-managed pain and increase in poverty because of the difficulty physically to preform the job they were trained to do. It\'s not fair to put everyone else, that is not currently dying, into a category and say you can\'t be treated for your chronic severe pain with an opioid greater than 100mg of morphine in strength or longer than 30 days at a time cause studies say you will most likely become a heroin addict. I know someone who\'s first time using an opioid was on the street to try and treat their own pain cause their doctor wouldn\'t. Those that truly have pain with no other relief, will search out for pain relief. Even if it means buying them on the streets or in other States. There really needs to be exceptions for those with chronic severe pain, period! And not all pain is black and white. There is not always an obvious answer to why some people are hurting, so a specialist would definitely be needed in these cases. Please allow those with chronic pain, not relieved by any other means, be an exception to the new law.

Peter Michaud, MMA (Sunday, May 01, 2016)

LD 1646

The limit applies only to opioid medications, and it relates to the proportion a particular medication has to morphine. So, for example, if medication "x" has a 2:1 relation to morphine, so that 50 mg of "x" equals 100 mg of morphine, the limit on "x" would be 50 mg. The Prescription Monitoring Program will be establishing a calculator that determines the proportions of various medications to morphine. You should speak with your physician or other prescriber if you have questions about your particular medicine.

Ryan graves (Friday, April 29, 2016)


Hello im a pain patient and I'm a little confused on the new law. 100 mg morphine equivalent...does this mean our limit is the 100 mgs on ANY pain med or what ever our pain med equals in morphine? ?

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