Opioid painkiller prescribing declined by 13.3 percent in Maine in 2017, the sixth-steepest drop in the nation and well above the national decline of 8.9 percent, according to a national report released Thursday.
As part of its strategy to lessen the opioid crisis, the Maine Legislature passed a strict new opioid prescribing law that went into effect in July 2016, and 2017 was the first year the law was fully implemented.
“The law was a big factor,” said Gordon Smith, executive vice president of the Maine Medical Association, which represents doctors before the Legislature. But Smith said Maine is still doing far too little to help people with substance abuse disorder obtain treatment. “We’re not doing enough, and what we’re doing we’re not doing quickly enough.”
Efforts to expand substance abuse treatment are still pending in the Legislature, and implementation of Medicaid expansion, which would substantially improve access to treatment, is stalled while Republican Gov. Paul LePage fights with the Legislature over how to fund it.
From 2013-17, opioid prescribing fell 22.2 percent in the United States and 32 percent in Maine. The total number of opioid prescriptions written in the state declined from 1.1 million in 2013 to 752,000 in 2017.
The Maine prescribing law – the only one of its kind in the nation when it was approved – limits dosages and the length of prescriptions for opioids, although there are some exceptions, including for people receiving end-of-life care.
Dr. Christopher Pezzullo, Maine state health officer, credited the new law with the positive results.
“It really was the right law at the right time,” Pezzullo said. “All of it has worked together to create a change in the prescribing culture.”
New Hampshire saw the sharpest decline in the nation at 15 percent last year, according to IQVIA, a health care consulting company that regularly gathers prescribing data from pharmacies across the country. New Hampshire has also developed new rules for prescribing opioids that started in 2017, although the rules are not as strict as Maine’s.
Limiting opioid prescribing is viewed as a preventive measure to reduce the number of people who become addicted to opioids. Four of five new heroin users started by abusing prescription opioids, according to the American Society of Addiction Medicine. Maine is in the midst of an opioid crisis, with 418 drug overdose deaths, an all-time high, in 2017.
There’s no evidence that opioids are effective in controlling chronic pain, according to the U.S. Centers for Disease Control and Prevention. A sweeping study published in March in the Journal of the American Medical Association found that opioids were less effective at alleviating chronic pain than over-the-counter painkillers.
Dr. Noah Nesin, vice president of medical affairs at Penobscot Community Health Care in Bangor, which offers substance use treatment programs, said the news is heartening, but there’s “still a long way to go.” Nesin said too many doctors still believe prescribing opioids is effective for treating chronic pain.
“There’s nothing to indicate that opioids are appropriate for managing chronic pain,” Nesin said. “There’s this belief that we still need to do this to be compassionate for some people who were on high doses of opioids. I don’t see any science behind that argument. People deserve to have a chance to live life without opioids.”
The Maine law requires that doses be under 100 morphine milligram equivalents, or MME, which is a standard measurement for opioid dosages. Pezzullo said the average dose in Maine has declined from 83 MMEs in 2015 to 68 in 2017. The law also mandates that doctors check the state’s prescription monitoring program – which helps prevent “doctor shopping” and over-prescribing. The prescription monitoring program’s utilization jumped from 320,000 in 2015 to 1.7 million in 2017.
Dr. Lisa Letourneau, associate medical director of Maine Quality Counts, a health advocacy nonprofit, said that while it’s good news that opioid prescribing has declined, she noted that it’s a “complicated picture” and that reducing prescribing doesn’t help people who are already addicted to heroin and in danger of dying from drug overdoses. In recent years, heroin has been mixed with fentanyl, a more powerful opioid that’s more likely to result in overdoses.
“This terrible epidemic could continue for who knows how many years,” Letourneau said. “We need to focus on treatment, treatment, treatment. Clearly, more needs to be done.”
Joe Lawlor can be contacted at 791-6376 or at:
jlawlor@pressherald.com
Twitter: @joelawlorph
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