“People in this room employ more than 2,500 prescribers. Are you paying attention to their prescribing practices?” That was the question posed to executive leaders by a member of the Maine Opiate Collaborative at the 2016 Small and Rural Hospital Conference. This year’s event (entitled, Beyond the Four Walls) acknowledged the important role hospitals play in community health and called for hospitals to provide more integrated approaches to health.
At one of the meeting’s forums, members of the Maine Opiate Collaborative (MOC) spoke candidly with the crowd. The information they shared was alarming. Last year there were 272 overdose deaths, and 995 drug-affected newborns, and Maine was #1 in the per capita prescription of long-acting opioids. This is particularly unsettling since an estimated 80% of people who become addicted to opiates begin with a prescription.
As the group was absorbing the information, I wondered if one of the paths toward a solution could be as simple as monitoring prescribing practices of physicians. In fact, Maine already has a monitoring program. In 2004 the State implemented a Prescription Monitoring Program (PMP), which is an electronic database that enables prescribers to check the history of a new patient and monitor treatment to reduce misuse of drugs like Methadone, Oxycodone and Valium. However, the voluntary program never really caught on. Panelists noted that just 7% of doctors enrolled in the PMP use it at least once per month. That’s about to change.
New legislation passed last session (Public Law Chapter 488) requires the use of the PMP by current prescribers and broadens the base of users to include pharmacists and veterinarians, who also dispense drugs that can be diverted and misused. The new law also puts strict new caps on prescriptions.
These are all important steps to take, but certainly not the only ones needed. Combatting the stigma that surrounds substance use disorders needs to be a significant part of every intervention. Re-framing substance use disorders and understanding and addressing them for what they are—chronic diseases—will be essential to addressing this public health crisis. It’s not an individual’s moral failing; it’s a serious disease that can be addressed through a multi-faceted approach that includes appropriate treatment and support.
On May 6th the MOC released an expansive set of recommendations. One thing consistently heard around the state was support for restoring Maine Care. Another suggested action is the development of more Medication Assisted Treatment services in primary care, especially in rural Maine. Doing both would assist individuals in need of treatment, and help to grow and sustain a strong network of treatment providers able to care for all who need their services. (See the Task Force recommendations and more about MeHAF’s support of the MOC here.)
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