Governor Paul LePage signed into law “An Act to Prevent Opiate Abuse by Strengthening the Controlled Substances Prescription Monitoring Program” (now PL 2015, c. 488) on April 19, 2016, making Maine the second state to pass legislation on the issue this year. In March, Massachusetts passed the nation’s first law limiting first-time opioid prescriptions.
Maine’s bill introduces new language into the state laws governing licensure of physicians, nurses, podiatrists, dentists, and veterinarians. Beginning January 1, 2017, providers will not be allowed to prescribe more than a seven-day supply of opioids within a seven-day period for acute pain or a 30-day supply within a 30-day period for chronic pain. The daily supply is limited to 100 morphine milligram equivalents (MME) of medication per day, which is an aggregated total in cases where an individual receives a combination of opioids. The language originally filed by Gov. LePage would have set the caps at three days for acute pain and 15 days for chronic pain.
The law allows a number of exceptions, including cancer pain, palliative care, end-of-life and hospice care, medication assisted treatment for substance use disorder, and other circumstances determined through rulemaking by the state’s Department of Health and Human Services. The law also includes a provision allowing individuals currently receiving more than 100 MME of opioid medication per day to continue to receive up to 300 MME until July 1, 2017, at which time the 100 MME limitation will apply.
In addition to the limits on opioids, Maine’s law:
- Requires prescribers to check the state’s prescription drug monitoring program (PDMP) when first prescribing an opioid or benzodiazepine—prescribers must also check the PDMP every 90 days thereafter for as long as the prescription is renewed;
- Requires dispensers to check the state’s PDMP when dispensing to a non-resident, dispensing for a prescription written by an out-of-state provider, or if an individual is paying cash despite having insurance information on file;
- Requires electronic prescribing for all opioid medications no later than July 1, 2017—providers and pharmacies unable to meet this requirement must receive a waiver from the state; and
- Requires providers to complete at least three hours of relevant continuing education every two years as a condition of prescribing opioids—Maine providers are required to receive a total of 40 hours of continuing education over two years.
The law also calls for specific enhancements to be made to the state’s PDMP. Specifically, the law calls for:
- A mechanism or calculator that converts dosages to morphine milligram equivalents;
- Broader access authorizations to authorize prescribers and pharmacists to allow staff members to access the PDMP on their behalf; and
- The ability for prescribers and pharmacists to tailor the functions of the PDMP to better fit their workflows.
In as many months, two states have set statutory limits on opioid prescribing and will begin requiring mandatory continuing education for prescribers. All eyes will be on Maine and Massachusetts to see the impact these policies will have on opioid abuse (including heroin) and prescription drug diversion.
Gov. LePage’s press release on the new law can be found here.
See our blog on recent legislation passed in Massachusetts.