AUGUSTA — As Maine health care providers approach July 1, they’re preparing for a new law that will go into effect and limit how many opioid painkillers they can prescribe to their patients.
The VA Maine Healthcare System, which is headquartered at the Togus campus in Chelsea, also is trying to lessen the doses of addictive painkillers that are prescribed to Maine veterans, but it’s not clear the federal program will be able to get all its patients below the state limit.
About 70 veterans enrolled at Togus now are being prescribed greater doses of opioid painkillers than what will be allowed when the state law takes effect, said Stephen Sears, chief of staff at Togus.
But Togus has been weaning all of its patients to lower doses over the last couple years, Sears said. Just a year and a half ago, he said, more than 250 veterans were being prescribed greater doses than what will be allowed under the new law.
To illustrate the complexity of some veterans’ health care needs, Sears gave the example of a combat-injured patient who has extensive nerve damage.
“I think we’ll get there for most people,” Sears said, referring to the state limit. “But I can’t say that for everyone. There are some (veterans) with complex medical issues. … You have to look at every individual case. What is it that we need to do for this person, and do they have a chronic palliative care diagnosis?”
Under the state law that was passed in 2016, physicians will not be allowed to prescribe more than 100 morphine milligram equivalents per day to their patients. The law includes a handful of exceptions, including for terminal cancer patients and those in hospice care.
Those prescribing limits were approved by state lawmakers in 2016, as part of a larger package of rules that were meant to fight the opioid epidemic. Widely attributed to the overprescribing of painkillers in the last decade, that epidemic has taken a grim toll, with 650 Mainers dying in the last two years after overdosing on prescription painkillers, heroin or other opiates. Drug overdose deaths are now averaging 1 per day in Maine.
Because Togus is federally run, it’s not actually bound by many state laws, and it’s not clear if the Maine Department of Health and Human Services will try to penalize the system’s physicians if their patients are being prescribed more than 100 morphine milligram equivalents per day after July 1. Two department officials did not respond to requests for comment on Tuesday.
But Togus providers still are trying to bring as many patients as they can down to that state limit. For one thing, Sears said, both the VA Maine Healthcare System and its parent agency have recognized the dangers of overprescribing opiates.
“We’ve been working on this for several years,” he said. “We started even before the (Maine) law was passed, as part of the overall, long-term strategy by the VA to long-term pain management. The way we looked at this was, we were trying to prescribe appropriately. … We have had a very organized approach, educating everyone in the organization and sending postcards to vets.”
Last fall, the investigative news outlet Reveal reported that the Department of Veterans Affairs was prescribing narcotic painkillers to 160,000 fewer veterans than it had three years earlier, a nearly 25 percent reduction.
“This is a big story,” G. Caleb Alexander, co-director of the Johns Hopkins Center for Drug Safety and Effectiveness, told Reveal. “One would expect large reductions in the number of veterans experiencing addiction and overdose.”
Another reason Togus is trying to bring its patients down to the Maine prescribing limit is so they can receive treatment outside the health care system without their prescriptions being interrupted. At the same time, the system is prescribing fewer opioids in the first place and trying to provide alternative pain remedies to veterans, such as acupuncture and chiropractic care, Sears said.
But while Togus is trying to taper patients off their painkillers, rather than cut them off cold, some advocates worry that it will be too much change in too little time.
“I’ve spoken to vets going through the process right now,” said Jerry Dewitt, the commander of the Department of Maine AmVets and a licensed social worker. “Some of them are a little concerned that the VA put them on the meds to begin with, and now they’re trying to take them away. Unfortunately, they have been overprescribed to begin with, and that made a lot of veterans addicted to meds. Now they’re weaning them off of it. You can’t just stop taking a medication and be careful, especially if you’re addicted to it.”
He added, “Some people have been on these meds for a long time, and you’re going to be on withdrawal. You’re going to have to treat the withdrawal symptoms.”
Dewitt’s concerns echo those that have been made in the civilian health care world.
After Maine passed its tougher prescribing rules, they’ve been criticized by patients who have taken painkillers in the past, but whose conditions don’t fall into one of the designated exemptions. Some of those patients recently testified before the Legislature in favor of changes to the law.
But Sears acknowledged the complexity of some veterans’ health care needs. That’s why he couldn’t guarantee all Togus patients will be prescribed fewer than 100 morphine milligram equivalents per day after July 1.
“Each patient has a slightly different case,” he said. “The overall goal of the health care system is to try to use these medications, which are necessary on occasion, in the safest way possible, and to minimize the side effects and minimize the effect of people becoming dependent on them.”
Charles Eichacker — 621-5642
Twitter: @ceichacker
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