[Pharmwaste] Maine May Adopt Some of Strictest Prescription Drug Rules in U.S.

Catherine Zimmer zenllc at usfamily.net
Thu Mar 3 09:26:10 EST 2016

Hi Deborah and all,

Deborah,  thanks for sending  this.  Of course while we all advocate for
reduced pharmaceuticals and appropriate prescribing practices, in this case
of this bill, I hope the palliative care practitioners step in.  


It is important for chronic pain sufferers to have access to relief.  My
mother has arthritis, spinal stenosis and fibromyalgia, providing her
adequate pain relief is a quality of life issue for her.  Without sufficient
treatment she is totally dysfunctional.  And, for someone who is in a
wheelchair, running to the pharmacy every 15 days with a paper scrip, or
trying to get a doctor to renew every fifteen days will be a burden.  My mom
worked through a palliative care clinic which was very helpful-they
monitored her, but also provided her the medications she needed on a
bi-monthly basis.  Still a bit burdensome, but not like 15 days would be.


And yes, I am still concerned about the excretion factor, but until we get
better drugs and better wastewater treatment, I don't know there is much we
can do in cases such as my mother's.   


Very truly yours,


Catherine Zimmer, MS, BSMT

Executive director, HEARRT Midwest

Principal, Zimmer Environmental Improvement, LLC

Reducing and managing healthcare related waste and costs for fifteen years.

St. Paul, MN 

Ph:  651.645.7509

 <mailto:zenllc at usfamily.net> zenllc at usfamily.net


From: Pharmwaste [mailto:pharmwaste-bounces at lists.dep.state.fl.us] On Behalf
Of DeBiasi, Deborah (DEQ)
Sent: Thursday, March 03, 2016 7:54 AM
To: (pharmwaste at lists.dep.state.fl.us)
Subject: [Pharmwaste] Maine May Adopt Some of Strictest Prescription Drug
Rules in U.S.




Health  <http://www.governing.com/topics/health-human-services> & Human

Maine May Adopt Some of Strictest Prescription Drug Rules in U.S. 

by Tribune News Service
<http://www.governing.com/authors/McClatchy-Newspapers.html>  | March 3,



By Joe Lawlor

The LePage administration on Wednesday introduced a bill that would create
new restrictions for prescribing opioids to control pain, as part of the
state's effort to combat the heroin epidemic. If approved, Maine would have
one of the strictest prescribing standards for opioids in the country, a
national expert said.

About 75 percent of new heroin users first become addicted to prescription
opioids, according to the American Society of Addiction Medicine.


.         Obama Rejects Governors' Pleas to Limit Painkillers

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You're Expecting

.         In 35 States, Young People Are Dying From Drug Overdoses at Double
the Rate

"This is a prevention bill," said Dr. Christopher Pezzullo, chief health
officer for the Maine Department of Health and Human Services. "There's way
too many opioids in our communities."

Maine is in the midst of a heroin crisis, and in recent years has
experienced a surge in overdose deaths and the number of people seeking
treatment for opioid addiction. About 350,000 Mainers were prescribed a
total of 80 million opioid pills in 2014, the latest figures available,
according to the Maine DHHS.

Under the new restrictions, doctors would be required to check the
Prescription Monitoring Program before prescribing opioids, and would have
to undergo mandatory training before being permitted to prescribe opioids,
among other reforms. The Prescription Monitoring Program is a tool that
helps prevent patients from "doctor shopping," by limiting duplicate
prescriptions for opioids.

Tom Clark, clearinghouse manager for the PDMP Center of Excellence at
Brandeis University, which researches and tracks prescription monitoring
programs and other regulations around prescribing, said Maine would vault to
among the strictest states in the nation for prescribing opioids.

"This is quite a signal," Clark said. "Maine is doing the right thing. This
tells me they're very serious about changing prescribing practices. It's a
very progressive proposal."

Currently, 27 states require doctors to use the state's prescription
monitoring program before prescribing opioids, but Clark said in some states
the requirements are weak and there's many loopholes.

Maine would join the dozen or so states that have a more comprehensive
mandate, and the other requirements Maine is proposing would put the state
at or near the top for strict opioid prescribing regulations, Clark said.

Other measures in the bill include:

* Limiting opioid prescriptions for chronic pain to 15 days, and acute pain
to three days.

* Capping opioid prescriptions to 100 morphine milligram equivalents per

Pezzullo said studies show that prescriptions higher than 100 morphine
milligram equivalents have greater potential to be harmful to the patient.
In a case study of eight states that included Maine, Maine had the second
highest percentage, at 15 percent, of doctors prescribing greater than 100
morphine milligran equivalents, according to a study published in October
2015 by the U.S. Centers for Disease Control.

In addition, research has shown that overall, opioids are ineffective and
many times counterproductive in treating chronic pain, and states are now
examining ways to limit prescriptions for chronic pain.

"We are facing a heroin crisis that was created in large part due to the
unchecked flood of prescription painkillers into our communities," said Gov.
Paul LePage in a statement. "It's time for some common-sense limits on
prescribing these dangerous and highly addictive pills. With limits in place
today, we can see a reduction in heroin addiction tomorrow."

Pezzullo said the administration has been working on the bill for months,
talking to experts across the country to devise a proposal that would make a
significant dent in opioid prescriptions.

"If these measures had only been in place 10 years ago, I doubt we would
have seen a heroin abuse crisis of today's magnitude," Pezzullo said.

The state in 2012 made changes to opioid prescribing for MaineCare patients,
and the state has seen opioid prescription rates for MaineCare, the state's
version of Medicaid, plummet over the last few years.

Opioid prescriptions in the MaineCare system declined by 45 percent from
2012 to 2014, while opioids prescribed using private insurance increased 5
percent during the same time period, according to the Maine DHHS.

But Wednesday's bill, if approved, would be much more strict than the
MaineCare rules, and would apply to all doctors in the state.

Clark said as the heroin problem has become more acute, more states are
adopting tougher rules for doctors who prescribe opioids. For example,
mandatory physician usage of prescription monitoring programs has been
expanded to many more states over the past five years, he said.

Dr. Brian Pierce, president of the Maine Medical Association, a trade group
that represents doctors and lobbies the Legislature on bills, said they
agree with the "intent" of the LePage administration's proposals, but want
to make sure flexibility is built in so that doctors are not hamstrung by

"We want it to work well for patients and physicians," Pierce said, adding
that the system should be designed so that if patients are having problems
overnight or on weekends, doctors could prescribe the opioids without
running afoul of state regulations.

But Pierce said the association did not disagree with the goals of the bill
or even with the idea that doctors should have mandatory training or be
required to use the Prescription Monitoring Program. Pierce said
over-prescribing of opioids has contributed to the heroin problem.

The bill was sponsored by Sen. Andre Cushing, R-Newport, assistant Senate
majority leader, but the proposal could attract bipartisan support.

Rep. Drew Gattine, D-Westbrook, and co-chair of the health and human
services committee, said he's "open-minded" about the bill, and agrees that
changes in prescribing practices should be considered by lawmakers.

The new regulations, if approved, would also apply to benzodiazepines, which
are powerful sedatives used to treat a variety of conditions, incuding
anxiety and panic disorders. Benzodiazepines have also been known to be
diverted and abused.

(c)2016 the Portland Press Herald (Portland, Maine)



Deborah L. DeBiasi
Email:    <mailto:Deborah.DeBiasi at deq.virginia.gov>
Deborah.DeBiasi at deq.virginia.gov
WEB site address:   <http://www.deq.virginia.gov/> www.deq.virginia.gov
Virginia Department of Environmental Quality
Office of Water Permits 
Industrial Pretreatment/Whole Effluent Toxicity (WET) Program
PPCPs, EDCs, and Microconstituents


Mail:          P.O. Box 1105, Richmond, VA  23218
Location:  629 E. Main Street, Richmond, VA  23219
PH:         804-698-4028      FAX:      804-698-4032


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