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Limiting Prescriptions to Reduce the Opioid Epidemic

Around now marks one year since Maine became one of the first states to put limits on their opioid prescriptions, namely the dosages that were given to patients. So, how successful were they? Pretty successful, as it turns out. Maine's law is considered the toughest law in the U.S. on these matters, but it has also raised some controversy, mainly among patients who suffer from chronic pain, like those with rheumatoid arthritis, as they are hesitant to let go of the medicine that they believe helps them function in their everyday lives.

Maine's new limit allows for a maximum of 100 morphine milligram equivalents to be given to most patients per day. A morphine milligram equivalent is the standard of measurement that is used to determine just how potent a particular opioid is. Some patients are granted exemptions, such as those suffering from certain kinds of cancer and those in hospice, among others.

Many patients who regularly took high doses of opioids found themselves growing angrier about their conditions as time went on, and so they tended to demand even higher doses of medication to function in their daily lives. One of the major problems with this was that continuing to increase their dosages meant they were also suffering from ever-present and increased side effects. The medications then became problems themselves and stood in the way of the patients ever recovering from their ailments, affecting things like their mood and memory..

Patients who held existing prescriptions were given a year to adjust to the new restriction. In nearly all of Maine's counties, the number of prescription painkillers that have been given out have dropped significantly. Gordon Smith, the executive vice president of the Maine Medical Association, said that the state experienced "the fourth largest drop in the country," with a 21.5 percent reduction in the number of opioids that were prescribed for the three-year period of 2013 to 2016.

This number, however, only accounts for the first few months after Maine's new law went into effect. Smith predicts the number will drop even more in the coming months once it is adjusted to fit the new restrictions. While doctors are thrilled, their patients have been having difficulty adjusting. 16,000 patients taking higher doses of opioids were expected to adjust to the new restrictions by July of 2017.

One such patient, Brian Rockett, the operator of a lobster business on the east coast, experienced "unbearable pain" when trying to adjust to the restrictions and even filed his intent to sue the state. Rockett feared that his pain would interfere with his daily operations and that he would lose his business over the restrictions that were now being forced upon him.

Dr. Geoffrey Gratwick heard the concerns of patients like Rockett, understanding that "a certain group of people simply cannot come off" their prescriptions. Gratwick recently pushed through an amendment to Maine's law that casts a wider net insofar as exemptions are concerned so that people who suffer from incurable and chronic conditions can continue to take their high-dose prescriptions.