AUGUSTA, Maine — Despite new exceptions that were added Friday to a law restricting prescription opiate dosages, it is still not clear whether two midcoast men will be allowed to continue taking their prescribed amount of opioids to manage chronic pain.
The new set of exceptions were adopted on March 31 just days after Brian Rockett of Owls Head and Eric Wass of Rockland, who each suffer chronic pain that is managed with high doses of prescription opiates, threatened to sue if adequate exceptions for palliative care patients were not added to the new law.
One of the most contested aspects of the new law, which will go into effect in July, is the regulation that a single dose of prescription opioids cannot exceed 100 morphine milligram equivalents, or mme, unless an individual qualifies under the set of exceptions. New exceptions to this standard added Friday include a patient receiving end-of-life or hospice care, pain associated with cancer or a pregnant woman with a pre-existing prescription for opioids that exceeds a daily dose of 100 mme.
The state has until April to enact emergency technical provisions to the law, such as the exceptions adopted last week, and until Jan. 1, 2018 to enact emergency substantive changes.
If the exceptions in the law are not made more comprehensive, the lawsuit will move forward, said Rockland attorney Patrick Mellor, who represents Rockett and Wass.
The law, which passed the Maine Legislature last year with support from Gov. Paul LePage and the medical community, is aimed at mitigating the opiate addiction crisis that continues to grip the state. The new set of rules will limit and gradually reduce a patient’s dosage amount of physician prescribed opioids such as hydrocodone and OxyContin.
“This legislation pulls the rug out from under many individuals who are already suffering from chronic pain,” Mellor said.
The statutory definition of what constitutes as palliative care under the new exceptions remains unclear, Mellor said, leaving the predicament that Rockett and Wass find themselves in unresolved. Palliative care is an intensive form of caregiving for people with chronic or serious illnesses that are sometimes but not exclusively life-threatening, such as cancer treatment and end-of-life hospice care.
The reality, Mellor said Tuesday, is that long-term “patients have been lawfully prescribed high doses of pain management medication for years and have become physiologically dependent on this pain management approach.”
The uniform standards and exceptions of the law are untenable, particularly for long-term, or legacy, patients like his clients, Mellor said. Rockett, a lobster wholesaler and Wass, a roofer, each suffer from degenerative disc disease.
The statutory definition of palliative care in the list of exceptions to the law, for example, applies to patients with “serious illnesses,” but the language is unclear whether non-life threatening conditions, like degenerative disc disease, qualify.
“The state’s current rules and statutes don’t adequately address the needs of patients experiencing chronic pain, and don’t provide adequate guidance for physicians,” Mellor said Tuesday.
Moreover, “the state needs to clarify the definition of palliative care,” Mellor added. If the state’s definition provided allowances for palliative care that aren’t exclusively end of life or treatment for a terminal illness, “that would go a long way toward solving the problem.”
In a situation when a patient and their physician have been treating chronic pain with opiates for years, the new law should provide an exception for that, Mellor said. “The physician should have the discretion to continue their patient’s care using opioid medications as one of the tools to help provide relief to their patients.”
Department of Health and Human Services spokeswoman Samantha Edwards said last week in a statement that the state “recognizes the insidious nature of chronic pain,” and that a palliative exemption and individualized care would be allowed.
But Mellor, who will meet Friday with the legislative task force in Augusta to discuss the law and its exceptions, said the language of the law is still unclear and prohibitive for individuals like Wass, Rockett and the group of legacy patients who rely on more than 100 mme of prescription opiates just to function in society.
For those individuals who suffer from chronic pain, tapering their doses down to 100 morphine milligram equivalents is “unreasonable,” Mellor wrote in the March 27 letter. Wass told WLBZ in an interview last week that he was taking 450 morphine milligram equivalents of medication — more than four times the regulated amount under the new law.
“Larger doses, often appearing extraordinary to those unfamiliar with Chronic Pain Syndrome, are needed for some of these individuals and must be properly timed for success in achieving adequate pain control,” Mellor wrote.
While the intention behind this legislation is to mitigate the substance abuse crisis and prevent it from debilitating another generation, “which is a goal we can all support,” Mellor said, “one size does not fit all.”
And, he added, even though tapering will work for some patients, “we know that it’s not working for everyone.”
Mellor said the legislation not only exacerbates the struggles of those individuals who are already suffering, and leave them with few options, one of which could be returning to the “street or black market for self medication.”
“Those aren’t options that should be forced on anyone,” Mellor said.