Maine – Could Prescription Painkiller Limits Help Solve Growing Heroin Plague?
Nationwide, there is a troubling and noticeable rise in overdose deaths from opioids – both prescription drugs and heroin. It has long been speculated that the increase in painkiller prescriptions since the 1990’s is responsible for the current heroin epidemic, as well.
The story goes like this: once a patient becomes dependent on a highly-addictive painkiller, such as OxyContin, he or she may turn to cheap heroin to fuel their habit. According to the American Society of Addiction Medicine, 80% of new heroin users were first addicted to prescription opioids.
Gov. Paul LePage is pushing for legislation which would limit how much pain medication physicians can prescribe. Given the addictive nature of these drugs, legal limitations are not unheard of. The Centers for Disease Control and Prevention (CDC) issued this document, which details many of the duration and dosage limitations for prescription opioids in other states.
But what about the patients who really need the drugs? Pain management is an important part of healthcare – especially for those with long-term chronic pain due to disease, cancer, and end-of-life situations. There are signs, however, that painkillers may be prescribed in doses greater than is appropriate.
As of 2012, Maine suffered from the highest rate of prescriptions for long-acting opioid pain relievers in the nation. According to the CDC, although prescription painkiller sales have tripled in the U.S. since 1999, people are not reporting less pain. Over-the-counter painkillers seem to do nothing for severe or chronic pain, but there are other alternatives, such as physical therapy and holistic treatments.
LD 1646 -This is Gov. LePage’s bill, It seeks to set limits on the amount of pain medication physicians may prescribe. Financial penalties would ensue for violating these limitations. It would make Maine’s prescription monitoring service and the electronic filing of all opioid prescriptions mandatory.
LD 1648 – This was introduced by the Maine Medical Association. It seeks to direct Maine’s Board of Medicine to develop the rules and limitations for prescribers, but that may not be a time-sensitive option.
The MMA considers LePage’s bill a bit too strict, although his limitations mirror the CDC’s latest recommendations (which are currently being criticized as being to rigid in their own right.)
What is likely needed is a compromise versus strict limitations – a set of recommended guidelines, along with the ability to identify and educate those provides who tend to have higher rates of opioid prescriptions. Focusing on improvement and harm reduction is probably more sensible at this point – rather than simply punishing those who legitimately need a prescription painkiller, or the prescribers who are trying to help them.
For example, the Bangor Area Controlled Substance Group has designed medical practice standards for painkillers prescriptions. Among the guidelines, the patient would use a single pharmacy, would participate in pill counts and urine testing, and would agree to not request early refills. Prescriptions for opioid painkillers are currently monitored via Maine’s Controlled Substances Prescription Monitoring Program.
~ G. Nathalee Serrels, M.A., Psychology