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Maine doctors write less prescriptions for opiates



Opioid prescribing in Maine has declined over the past five years, including a 14.1% drop in 2018, a positive sign since the state is struggling to control an outbreak of substance abuse that fed an overdose of one death every day.

Since 2013, Maine opiate prescriptions have fallen by 41.5%, according to newly published statistics. The decline occurs when Maine and other countries apply restrictions reflecting the wider recognition of the role that prescription drugs play in the opioid crisis.

Maine's five-year decline is the seventh largest in the country and its year-on-year decline is the 12th highest among states and the Colombia region. National opioid prescription decreased by an average of 32.9% from 201

3-18 and only 12.4% in 2018. The country's capital experienced the largest decline, with 52.3% fewer prescriptions for opiates in 2018 compared to 2013

"This is a very significant reduction in prescribing of opiates in Maine, and from a health point of view, this is a good thing. "Said Dr. Noah Nessin, chief medical officer at Penobscot Health Center in Bangor. "To the extent that the physician is fully committed to their patients and conducts a rational and compassionate program, the quality of life is improving. But some patients pull out the carpet from them and they have no positive experience. "In Nesin's clinic, 77% of patients who had previously used opioids for chronic pain no longer use them. They use a "multifaceted" approach that can include therapy, yoga, nutrition, and prescription drugs. There is no evidence that opioids are effective in controlling chronic pain, says Nessin, and opioid drugs can cause overdosage and lead to a disorder of substance use. With fewer prescriptions of opiates, there are more patients, like Drew Floyd of Portland, of opioids for chronic back pain two years ago. Floyd, a patient at Mercy Hospital, was reduced to a low dose of opioids before the law that would require her to come into force.

Floyd, 38, said he used a combination of therapy, exercise, osteopathic corrections and medical marijuana to control his pain.

"In general, pain is no worse than when I was taking opioids, and I do not get terrible headaches anymore, and I do not have so much stomach problems," Floyd says. previously received vicodin, Oxycontin and tramadol opioid painkillers. "Professionals outweigh the minuses."

She said she must rest more, which is better for her body. When she is taking painkillers, she will "overeat with things," which ultimately makes her feel worse, she said.

Nissin said that patients in the Penobscot health center who are weaned with opioids have a better quality of life and have generally been successful.

The total number of opiate prescriptions written in Maine has decreased from 1.1 million – or the equivalent of almost one opioid prescription for every Maine resident in 2013 – to 646,986 in 2018, according to IQVIA, a study

Death from drug overdose in Maine has fallen from 417 in 2017 to 354 in 2018, with the first reduction after years of overdose deaths. However, experts have warned that there is no link between prescribing and overdose death, as the opioid crisis is a complex issue involving many factors, including whether the state has strong prevention and treatment programs and the presence of illegal opiates such as heroin and fentanyl. 19659002] However, the role of prescription drugs to fuel the substance use disorder is significant. Four of the five new heroin users began to abuse prescription painkillers, according to the American Society of Drug Addiction.

Smith and other experts said that the strict Maine Settlement Act – which came fully into force in 2017 – is probably a contributing factor in reducing prescription rates.

He pointed out that the Act not only prescribes prescribing limits, but also requires doctors to carry out opioid prescription training courses. These courses, he said, have raised doctors' awareness of opioid dangers.

"Now almost every doctor who prescribes, understands that they should be careful when prescribing opioids," Smith said.

Maine is one of the first countries to approve stringent prescriptions for prescribing opioids in 2016, and 27 other countries have passed laws or developed stringent prescribing rules since then, such as dose limits. Maine, for example, limits doses up to 100 milligrams morphine per day for non-severe pain, with a few exceptions, such as for cancer patients.

"Less prescribing of opioids will clearly correlate with better results in society," says Michael Kleinrock, research director of the IQVIA Institute for Human Data and Sanford resident.

Nevada recently approved severe new prescription standards, and the state experienced the largest drop in opioids administered in the country in 2018, at 22.5

Kleinrock says it remains to be seen what levels of prescribing opiates will provide the right combination of pain control for some patients without contributing to substance abuse and overdose deaths. He said he expects the prescription to continue to decline to return in the early 2000s. Currently, opioid prescription has declined to approximately the middle of the 2000s in the United States, but is still about twice as prevalent as in the 1990s, before the opioid prescribing chronic pain has become widespread. prescribing.

р. Charles Pattavina, head of the emergency department at St. Joseph's Hospital in Bangor, said there has been a noticeable change in patients' attitudes towards opioids in recent years. "We see more people who want fewer pain medications in emergencies. "said Pattawin, who is chairman of the Maine Medical Association. "Because of all the deserved news of the opioid crisis, many patients seem more likely to take a dose or prescription to treat opiates. Rather, they would suffer some pain rather than take any risks. "

Kleinrock says another factor that has led to increased opiate use is a shorter stay in the hospital. Decades ago, patients would stay longer in the hospital after surgery, and until then their pain has been reduced to such an extent that they do not need pain prescription. But in patients enrolled a day or two after surgery, doctors prescribe opioids for home use, often for longer than needed.

"Dynamics is not as simple as overproduction leads to addiction, devaluation and death, tragic. This is much more complicated than that, "says Kleinrock.

For example, prevention and treatment programs are critical as well as the expansion of Medicaid, making treatment more accessible to patients with drug use disorders that can not afford treatment and have no health insurance

Mein realized Medicaid expansion this year as a drug treatment of potentially thousands of Mainers. Governor Janet Mills responds to the opioid crisis as one of her most important priorities.

Andrew McLean, a spokesman for the Maine Medical Association, said that in some cases prescribing law "strains the relationship between doctors and patients" because some patients feel they are not adequately relieved of pain, the law has a positive overall effect, reducing unnecessary prescribing of opioids.


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