TESTIMONY OF THE MAINE MEDICAL ASSOCIATION

IN OPPOSITION TO

L.D. 1082, AN ACT TO PROVIDE ALTERNATIVE PAIN TREATMENT BEFORE TREATMENT WITH OPIOIDS

Joint Standing Committee on Health Coverage, Insurance & Financial Services
Room 220, Cross State Office Building, Augusta, Maine
Thursday, March 21, 2019, 1:00 p.m.                                                   

Good Afternoon Senator Sanborn, Representative Tepler, & Members of the Joint Standing Committee on Health Coverage, Insurance & Financial Services.  My name is Andrew MacLean, Interim CEO of the Maine Medical Association (MMA), and I am pleased to be here today to speak in opposition to L.D. 1082, An Act to Provide Alternative Pain Treatment Before Treatment with Opioids.

The MMA is a professional organization of more than 4300 physicians, residents, and medical students in Maine whose mission is to support Maine physicians, advance the quality of medicine in Maine, and promote the health of all Maine citizens.

The MMA appreciates Senate President Jackson’s commitment to advancing health policy in Maine, including his work to provide universal health insurance coverage, to lower the cost of prescription drugs, and to respond to the opioid use disorder (OUD) crisis in our state. 

But, in L.D. 1082, I would respectfully argue that the proposal is an unwarranted intrusion into the professional judgment of physicians and other clinicians who prescribe and into the clinician-patient relationship. 

The MMA has acknowledged the role of over-prescribing of opioid medications in our OUD problem.  The medical community, through the efforts of professional organizations like MMA and regulatory agencies like the Board of Licensure in Medicine, has taken strong action to educate its members about appropriate prescribing of opioid medications, including consideration of alternatives to opioid medications for pain management.  The Maine legislature also has enacted boundaries on opioid prescribing through P.L.  2015, Chapter 488, as amended, and tools for prescribers such as the Controlled Substances Prescription Monitoring Program (the “PMP”).

During the Committee’s consideration of L.D. 558 earler this session, you received evidence of the substantial efforts made by MMA and the Department of Health & Human Services in opioid prescribing education through our MICIS Program.  The Board of Licensure in Medicine and Maine Quality Counts also have been important partners of MMA in these educational efforts.

In addition to the legislative and voluntary educational initiatives mentioned above, I want to draw the Committee’s attention to Joint Rule Chapter 21, Use of Controlled Substances for Treatment of Pain, a joint rule of the two physician licensing boards and the nursing board.  Recently updated, this administrative rule provides comprehensive guidance for clinicians on the standard of care and “best practices” in the prescribing of opioid medications.  I have attached for your reference, a copy of Joint Rule Chapter 21 and I have underlined specific text on pages 5 and 8 setting out an expectation that clinicians will consider alternatives to opioid medications for treatment of pain.  I also note that the two physician licensing boards have had a similar rule in place since 1999.

Beyond the policy arguments against the bill, I see many technical issues with the drafting.  While it attempts to exempt certain diseases from the requirement to try an alternative treatment first, it does not distinguish between “acute” and “chronic” pain, a critical difference that is widely accepted by clinicians and recognized in these laws.  It might be appropriate to consider alternative treatments before opioid medications for chronic pain, it probably would not be appropriate for acute pain, such as post-surgery pain.  The bill is not clear on what types of alternative treatment would satisfy the 24-session requirement or whether a combination of physical therapy and acupuncture, for example, would satisfy the requirement.  Finally, the insurance coverage provisions of the bill attempt to address MaineCare, the State Employee Health Plan, and private health insurance coverage, but it is not clear how the cost sharing aspects of these provisions would apply in practice.

Because of the concerns outlined above, the MMA recommends an “ought not to pass” vote on L.D. 1082.

Thank you for considering the views of the MMA on L.D. 1082.  I would be happy to respond to any questions you may have.