Maine doctors are prescribing far fewer opioids to patients compared with several years ago, a trend that experts say bodes well for future alleviation of the opioid crisis.
However, it’s unknown how long it will take for the decline to have an impact on addiction rates and deaths, and the prescribing rates vary widely, with two of Maine’s 16 counties actually seeing an increase.
The prescribing trends are captured in two reports – a county-level analysis published last week by the U.S. Centers for Disease Control and Prevention, and a national report with state-level data prepared in the spring by a Connecticut health consulting company, QuintilesIMS.
The Quintiles report, done for the American Medical Association, showed that the number of opioid prescriptions in Maine fell 21.5 percent from 2013 to 2016. That’s the fourth-highest drop in the nation, which averaged a 14.6 percent reduction in the same period. Maine’s 0.7 per-capita opioid prescription rate now matches the national average.
Easy access to the painkillers has been cited as a major factor in the opioid epidemic.
Four out of five new heroin users were first addicted to prescription opioids, according to the American Society of Addiction Medicine. Fueled by opioids, Maine had 376 drug overdose deaths in 2016, averaging more than one per day, an all-time high.
SHIFT IN MEDICAL COMMUNITY
The opioid crisis has reached every corner of Maine and all demographic groups and income levels. Nationally, more people now die from drug overdoses than vehicle accidents.
The downward prescribing trend is “an important piece of the puzzle,” said Bob Fowler, executive director of the Milestone Foundation, which operates a substance abuse detox center in Portland and a residential treatment program in Old Orchard Beach. “There’s been a real culture shift in the medical community,” Fowler said.
He said he hopes the ripple effect will happen quickly. With fewer people becoming addicted from over-prescribing of opioids, a smaller number would then turn to heroin or illicit use of pills.
But Steve Cotreau, program manager at the Portland Community Recovery Center, a support center for people in recovery, said he believes it will take a long time for prescribing trends to affect the number of people who need help. There’s hardly any treatment capacity in Maine, and many people are still overdosing and dying, Cotreau said.
“That’s long-distance good news,” he said. “It may help prevent people from falling in, but there’s people already in the water. Opioids are now so much a part of the using culture. It’s already established.”
Although opioid prescribing has declined, it has done so unevenly, according to the federal CDC, with some counties prescribing six times more opioids than other counties. In Maine, Kennebec County had two to three times more opioid prescribing than lower-prescribing counties such as Lincoln, Cumberland and Franklin. Somerset County also saw a slight increase in prescribing.
The CDC report, which compares 2010 with 2015, measures the average morphine milligram equivalent per capita in capturing dosages along with the number of prescriptions.
MAINE LAWS MAY ADD TO DROP-OFF
Although the CDC and Quintiles reports show substantial declines in opioid prescribing, it is still three times more prevalent compared with 1999, the CDC report said.
Maine has also approved a strict new prescribing law that went fully into effect in January, with some provisions starting in July 2016. The law limits dosages for some patients and the length of prescriptions, among other reforms.
“I expect that we will see these numbers drop further in 2017,” said Gordon Smith, executive vice president of the Maine Medical Association, which represents doctors before the Legislature. He said with the law now fully in effect, there should be even less opioid prescribing. The law is also intended to clamp down on “doctor shopping” by patients, a tactic used to obtain more opioids.
Maine also had approved Medicaid reforms in 2012 that limited opioid prescribing among Medicaid patients.
Dr. Elisabeth Fowlie Mock, a Holden pediatrician, criss-crosses the state for the Maine Medical Association hosting informational sessions about the science behind opioids, including the lack of evidence that painkillers are effective in treating chronic pain.
Mock said she’s getting a better reception from physicians now, compared with when she started 18 months ago.
“The legislation was based on good science, and now people are more engaged and willing to enter into the discussions,” Mock said. “It’s such a huge problem you can’t ignore it anymore.”
Mock said the change in practices is following a pattern – with some early adopters, more who will follow the pack once it becomes clear a change needs to happen, and others who are still resisting change.
Her sense is that in Maine, word is getting out and there are now many in the “pack” who are following the lead of those championing prescribing reform.
“For those still resisting, they’re saying that their patients are different and that they deserve the medication. My statement to them is always that their patients deserve the opportunity to be off the medication for six months and to see what happens,” Mock said.
PAIN SOLUTIONS STILL ELUSIVE
Dr. Patrice Harris, a member of the American Medical Association board of trustees and the association’s opioid task force, said the AMA is “pleased” to see the decline in opioid prescribing.
But she said prescribing is only one part of the big picture in the opioid crisis, and it’s unclear what the correct level of opioid prescribing should be. It depends on patient needs and what other tools physicians have to alleviate their patients’ pain, Harris said.
She said it would be helpful, for instance, to have other pain-relieving methods, such as physical therapy, be covered better by insurance companies.
“The financial incentives should be aligned to support these alternatives,” Harris said. “Pain is very complicated. This epidemic has evolved and will continue to evolve.”
Joe Lawlor can be contacted at 791-6376 or at:
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