Maine has experienced a sharp decline in high-dose opioid prescriptions since 2015, and much of the decrease has occurred since a new law restricting such prescriptions began to go into effect three years ago.
Patients with high-dose opioid prescriptions – those over 100 morphine milligram equivalents per day – plummeted from 29,444 patients in 2015 to 12,281 in 2018, a 58 percent decline, according to state statistics.
The 2019 statistics appear to mirror last year’s, with 6,734 patients on high-dose opioids through June 30.
“This basically shows that we are going in the right direction, but we need to keep working at it,” said Gordon Smith, director of opioid response for Gov. Janet Mills’ administration.
High-dose opioid prescriptions are strongly correlated with opioid overdose deaths, national research has shown. Overdose deaths occur in one out of every 32 patients taking high-dose opioid prescriptions, according to the U.S. Centers for Disease Control and Prevention.
Maine’s drug overdose deaths have also declined as high-dose opioid prescriptions decreased, although health experts caution there’s no proof yet that changes in the prescribing law are factors in the decline in overdose fatalities. Drug overdose deaths dropped from 417 in 2017 to 354 in 2018, according to state statistics, and 2019 deaths are on track to be somewhat lower than 2018.
The prescribing numbers are from the Maine Department of Health and Human Services prescription monitoring program and include patients who had at least one day of a high-dose opioid prescription. The monitoring program is designed to track prescriptions and help prevent “doctor shopping” by patients trying to circumvent the system.
Maine passed a law in 2016 that went partially into effect in 2017 and fully into effect in 2018 that limits the dosage and length of opioid prescriptions. Doctors and nurse practitioners were mandated to taper existing patients to a lower dose unless the higher dose could be justified. Exceptions can be given for palliative care, cancer pain, hospice care, acute pain and other conditions.
“Most people who are tapered down to a low dose or off of opioids entirely have the same levels of pain or less pain than when they were taking a high-dose opioid prescription,” said Dr. Elisabeth Fowlie Mock of Bangor. Medical research shows that opioids are ineffective for controlling chronic pain, Fowlie Mock said.
Michael Wyllie, 41, of Pittsfield said he had a high-dose morphine prescription after a 2011 car accident caused severe leg and head injuries. But he tapered off the opioids in 2012 and now uses medical marijuana to control pain.
Wyllie said getting off his opioid medications improved his quality of life.
“I’m able to function now and not feel like I’m half asleep all the time, or always feel like I’m going to get sick,” Wyllie said.
Fowlie Mock said doctors need to strike a balance rather than avoid all opioid prescribing because of the new law.
“If there’s a little old lady who needs one or two pain pills, we should not be punishing her because we have this law,” Fowlie Mock said.
Dr. Noah Nesin of Bangor said the law has done its job and should help reduce substance use disorder, but he would like to see the state consider tightening a loophole in the palliative care exception. Palliative care is given to patients with severe illnesses, but in Maine, the definition is so broad it allows doctors to prescribe opioids for many reasons that are not justified, Nesin said. He suggested that the state should narrow the definition or make doctors do more to justify opioid prescriptions for palliative care.
Nesin, chief medical officer of Penobscot Community Health Center, said reducing opioid prescriptions for chronic pain can and should be done.
He said the Bangor center went from 1,400 chronic pain patients with an average opioid dose of 200 morphine milligram equivalents in 2013 to 330 chronic pain patients now, with fewer than five of them prescribed a dose of 100 morphine milligram equivalents or higher.
“Many providers are learning the skills as they go of how to wean patients off of opioids,” Nesin said. “Telling patients they are better off without opioids for their chronic pain is not an easy message to deliver.”
Smith said more data and research must be conducted before any recommendations could be made to make the prescribing law stricter.
“It’s not clear to me how much lower we can drive these numbers down, and do it safely for the patients,” Smith said.
Total opioid prescribing has dropped 41.5 percent in Maine since 2013, according to IQVIA, a health care research company in North Carolina.
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