The reform bill will require all prescribers in the state to participate in the Prescription Monitoring Program, which places limits on the strength and duration of opioid prescriptions, requires providers to e-prescribe controlled substances, and necessitates that prescribers go through addiction training every two years.
The law, titled “An Act to Prevent Opiate Abuse by Strengthening the Controlled Substances Prescription Monitoring Program,” responds to the overwhelming challenge to manage opioid prescription abuse and heroin addiction.
An estimated 75 percent of heroin addicts began by abusing prescription opioid medications and those who are prescribed opioids are 40 times more likely to turn to heroin.
Only about 7 percent of prescribers use the current Prescription Monitoring Program, which includes a state-wide database of prescription information.
The law intends to better manage controlled substances in efforts to stop opioid abuse and subsequent heroin use.
“Heroin addiction is devastating our communities,” said Gov. LePage. “For many, it all started with the overprescribing of opioid pain medications. We can prevent many people from even trying heroin in the first place by putting these limits on the flow of pain pills into our homes. I am thankful to prescribers and pharmacists who helped to craft this legislation and ultimately support it before the Legislature. They recognize that the status quo hasn’t worked and it’s time for some serious reform.”
Starting in July 2017, healthcare providers will need to electronically submit opioid and benzodiazepine prescriptions to pharmacies. By e-prescribing, Maine aims to prevent drug abuse and empower healthcare providers to recognize potential abuse.
Prior to writing prescriptions for controlled substances, healthcare providers, including physicians, nurses, dentists, physical therapists, and even veterinarians, must check the Prescription Monitoring Program. This applies to all prescriptions that will be filled and administered outside of a license healthcare setting.
Pharmacists are also required to check the program before prescribing to new patients, individuals from outside of Maine, and patients who are paying cash even though they have insurance.
If prescribers are unable to e-prescribe, they may apply for a waiver from the state’s Department of Health and Human Services.
Maine will also enact a strict cap on the daily usage of opioid prescriptions. The law states that new patients will only be allowed 100 morphine milligram equivalent a day.
The state’s limit on the morphine milligram equivalent is modestly higher than the 90 outlined by the Centers for Disease Control guidelines. However, the new cap is lower than the limits in Massachusetts and Washington, where patients are allowed 120 morphine milligrams equivalent.
To help current patients with opioid pain medications, Maine will allow individuals to have a 300 morphine milligram equivalent until the cap is in place in July.
Under the new law, prescriptions are also restricted to seven days for patients with acute pain and 30 days for patients with chronic pain starting in January 2017.
Additionally, boards that manage healthcare providers who prescribe opioids will need to add three hours of controlled substance abuse training to the existing 40 hours of Continuing Medical Education program every two years.
The state’s Department of Health and Human Services intends to release some exemptions to the law. Patients in hospice and palliative care as well as those suffering from cancer may not have to abide by the new opioid limits.
“This is a prevention bill and it is designed to get at one of the root causes of the heroin crisis in Maine,” said Christopher Pezzullo, MD, Chief Health Officer for Maine DHHS. “This new law is in line with the latest clinical research, and it reflects the direction many prescribers are already heading in; it just sets new expectations to ensure prescribers are adjusting their practices to account for the tragic realities of opioid addiction. There are, however, ‘safety valves’ incorporated throughout this law to prevent unintended consequences.”
New York has also enacted an e-prescribing law earlier this year. Despite many delays, prescribers in New York are now required to electronically prescribe controlled substances.