TESTIMONY OF THE MAINE MEDICAL ASSOCIATION

NEITHER FOR NOR AGAINST

L.D. 1363, RESOLVE, REGARDING LEGISLATIVE REVIEW OF PORTIONS OF CHAPTER 11:  RULES GOVERNING THE CONTROLLED SUBSTANCES PRESCRIPTION MONITORING PROGRAM AND PRESCRIPTION OF OPIOID MEDICATIONS, A LATE-FILED MAJOR SUBSTANTIVE RULE OF THE DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Joint Standing Committee on Health & Human Services

Room 209, Cross State Office Building

Thursday, April 20, 2017, 1:00 p.m.

Good afternoon Senator Brakey, Representative Hymanson, and Members of the Health and Human Services Committee.  I am Gordon Smith, a resident of East Winthrop and Executive Vice President of the Maine Medical Association.  I am here today to speak “neither for nor against” L.D. 1363.

 The MMA is a professional organization representing more than 4000 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.

We appreciate the work that the Department put into the emergency rule and the final rule.  The proposed final rule received nearly 100 comments and DHHS staff responded to each comment in a 66-page document.  There is much in the rule we like.  But, we had requested a number of changes to the emergency rule, some of which we believe are essential to the efficient operation of the health care system, and several of our recommendations were rejected.  We renew our request for these adjustments to the law and the rule and I have attached our comments to the rule filed with the Department back in February. 

For the most part, our recommendations mirror those of the Maine Hospital Association which Jeff Austin has either presented to you or will be doing so. 

In order of priority, we believe the following substantive changes are essential:

1. We support an exemption to the 100 MME limit for the administration of opioids associated with outpatient surgery.  We concur with the Hospital Association that this could be best accomplished by adding the phrase, and to a person in connection with a surgical procedure.  The addition of this language will ensure that the hundreds of Maine patients undergoing outpatient procedures will not be compromised in the pain relief provided through anesthesia.  Limiting these medications was never the intent of the Chapter 488 and enacting this change will not increase the risk of diversion or addiction.
2. Many emergency physicians have commented negatively on the mandated reporting of ED dispensing to the PMP.  Understand that this mandate is different than the requirement of checking the Prescription Monitoring Program, which we do not oppose.  The current requirement that the dispensing of even a single opioid pill to a patient in the ED requires such a report is onerous, unnecessary, and likely to result in unintended consequences.  It should be removed.
3. We do not believe that pharmacists would be required to communicate with PMP Office if fraud is suspected given the very broad definition of fraud being used.  What the pharmacist should do is communicate with the prescriber to see if a code could be missing or other error had been made.  And we also believe the pharmacist should be permitted to add an exemption code if the prescriber provides that information orally.
4. We believe that there should be an additional exemption from the MME limits for patients in chronic pain who have attempted to taper their dose and who have struggled and lost function as a result.  While DHHS suggests in response to the many comments filed that the palliative care exemption be used, many prescribers are not comfortable with this non-traditional use of the term, palliative care.  Many patients have paid a cruel price for getting caught in this vice between the law and the prescribers.

Thank you for the opportunity to present these comments to you and I would be happy to answer any questions you may have.