Gratwick bill restores doctor-patient relationship in pain treatment

Posted: April 21, 2017 | Senator Gratwick

AUGUSTA — Doctors and patients turned out Thursday to support a bill by Sen. Geoff Gratwick, D-Bangor, that would provide much-needed flexibility to doctors in prescribing opioid medications to patients with severe, chronic pain.

The legislature previously enacted a law to cap the strength of prescription opioids at 100 morphine milligram equivalent daily opioid limit. Since that bill became law, elected officials have been bombarded with calls by patients with severe and chronic pain could not adequately manage that pain under the new limit. Some even said they may be forced to the black market in order to simply live their lives.

Sen. Gratwick’s bill — LD 1031 “An Act To Establish Reasonable and Clinically Appropriate Exceptions to Opioid Medication Prescribing Limits” — preserves the limit, while giving doctors the ability to prescribe higher doses of opioids when necessary, after documenting a demonstrated medical need.

“The death toll from the opioid epidemic is staggering, and the Legislature has a compelling reason to act to limit the carnage,” said Sen. Gratwick, a retired doctor. “The cap on opioid prescription strengths was a well-meaning attempt to keep Mainers from inadvertently becoming addicts. However, it has had serious unintended consequences on Mainers suffering from severe and chronic pain. We have to fight the drug crisis, but we also have to let doctors work with their patients to devise treatment plans that work.”

Dr. Stephen Hull, a board-certified pain medicine physician at Mercy Hospital, testified in support of the bill. Hull participated in the rulemaking process associated with opioid prescription strength cap, and told the Health and Human Services Committee on Thursday that even the very best studies indicate that even pain patients who try valiantly to get off opioids find that they cannot function without them.

“It is my opinion that when a patient has made a concerted effort to taper below 100 morphine milligram equivalents, but has sustained substantial functional decline, we as a prescriber and you as legislators not to be willing, with the patient, to accept the individual risk of high dose opioid in favor of the demonstrable benefits for that individual.”

Dale Mosher, a chronic pain patient in Bowdoinham, said he first injured his back in 1965, but it wasn’t until 2004 that he finally received a diagnosis — a tear in the annulus of three disks. Physical therapy, the occasional use of a brace and opioids help him manage his pain.

He told the Health and Human Services Committee that “For some people, opioids are not tolerable. For some they are not very effective, and some get addicted by merely opening a bottle. For the rest of us, they do indeed work.”

“You as legislators are not doctors or gods,” Mosher said. “There is no way possible that you can legislate what is a reasonable dosage. That needs to be determined by the patient and their doctor.”

The Health and Human Services Committee will conduct a work session on LD 1031 in the coming weeks, after which it will receive votes in the House and Senate.