State Law Pushes Doctors To Taper Most Patients' Opioid Doses : Shots - Health News Maine is among a handful of states putting limits on the painkiller dose that doctors can prescribe a patient. Some doctors and patients say the law is helping, while others say it goes too far.
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Intent On Reversing Its Opioid Epidemic, A State Limits Prescriptions

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Intent On Reversing Its Opioid Epidemic, A State Limits Prescriptions

Intent On Reversing Its Opioid Epidemic, A State Limits Prescriptions

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AILSA CHANG, HOST:

One year ago, Maine was one of the first states to set limits on opioid prescriptions. It's an attempt to slow down the flow of the pills that are fueling a nationwide epidemic. The law is considered the toughest in the nation. And it's largely viewed as a success. But it hasn't been without controversy. Maine Public Radio's Patty Wight reports.

PATTY WIGHT, BYLINE: Name a surgery and there's a decent chance Ed Hodgdon has had it.

ED HODGDON: Knee replacement, hip replacement, elbows. I've got screws in my feet.

WIGHT: Hodgdon has rheumatoid arthritis. Along with those surgeries came opioid prescriptions for pain. But he says the pain never went away.

HODGDON: It numbed it for a while. And then I needed more.

WIGHT: So gradually over time, you needed a higher dose.

HODGDON: Higher dose, yeah. And then I found Dr. Medd. And that's my angel right there.

WIGHT: Dr. Donald Medd is a general internist. Last July, Maine capped new prescriptions for opioids to a maximum of 100 morphine milligram equivalents per day. That's the standard used to measure potency for all prescription opioids. Patients with existing prescriptions were given a year to meet that limit. But Dr. Medd had already started to taper high-dose patients like Hodgdon a few years before after he noticed many grew increasingly angry about their pain and demanded more medication.

At the same time, they struggle to function in daily life.

DONALD MEDD: Yeah, at some point, the medications get in the way of some sort of recovery.

WIGHT: Hodgdon says the opioids affected his mood and his memory. Dr. Medd cut his prescription by two-thirds and connected him to a psychologist. Hodgdon still lives with some pain. But his life, he says, is infinitely better.

HODGDON: I can remember things. I get along better with people.

WIGHT: Despite success stories like Hodgdon's, Dr. Medd initially opposed Maine's law. He didn't want the legislature to interfere with medicine. But now he thinks the law gave a necessary nudge. Combined with early efforts, Medd says his medical group has cut its number of patients on opioids for chronic pain almost in half from about 1,500 to 800. Gordon Smith of the Maine Medical Association says overall, the state of Maine has seen a drop in painkiller prescriptions.

It's a trend that he says was underway even before the law took effect.

GORDON SMITH: We had the fourth-largest drop in the country, 21.5 percent reduction in opioid prescriptions from 2013 through 2016.

WIGHT: That data only includes the first few months of Maine's prescribing cap. Smith says he expects the law will accelerate further reductions.

SMITH: Now, having said that, it's not been easy. It's been particularly difficult for patients.

WIGHT: Specifically, the 16,000 patients on high-dose opioids who are expected to taper to the 100 morphine milligram limit by July of this year.

BRIAN ROCKETT: I was about four times above that.

WIGHT: Brian Rockett operates a wholesale lobster buying business on the Maine coast. He started taking opioids years ago for injuries from racing motorcycles and boats. Rockett says when he tried to taper, he had unbearable pain. He filed an intent to sue the state.

ROCKETT: I just knew that I was facing possibly losing my business.

GEOFFREY GRATWICK: A certain group of people simply can't come off it.

WIGHT: Geoffrey Gratwick is a retired rheumatologist and a state lawmaker. He recently pushed through a change to the law that allows broader exemptions so that people with incurable, chronic conditions can take high doses.

GRATWICK: It put the decision about that back into the hands where it should be, the doctor and the patient.

WIGHT: Under the revised law, Ryan Rockett was able to increase his dose and dropped the lawsuit. Even though more patients could potentially seek exemptions, Maine's law is seen as an important step. Recent data from the federal Centers for Disease Control found that nationwide, despite an overall decrease in recent years, the number of opioids prescribed is still triple what it was in 1999. For NPR News, I'm Patty Wight.

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