If Maine’s opioid law is working, why so many overdoses?

Yesterday we learned that drug overdoses continue to kill an average of more than one person a day in Maine. A press release from Maine Attorney Janet Mills’ office stated that between January and June, 185 deaths were linked to drug overdoses.

That’s on pace with the same period last year, when 193 people died.

Prescription narcotics were cited as a “disturbing factor in these overdose deaths.”

“The opioid epidemic continues to devastate our communities, both rural and urban, all across Maine,” Mills said. “It is the greatest challenge of our time.”

But then today, the Maine Department of Health and Human Services announced that relatively new limits on opioid prescribing in Maine are “showing early signs of success.” State data “revealed a steady decrease” in prescriptions for addictive opioids since the law, introduced by Gov. Paul LePage, took effect last July. This suggests patients are weaning off high-dose prescriptions, the release states.

So we have one state office warning that overdose deaths essentially continue unabated, driven in large part by prescription drugs. Fewer than 24 hours later, we have another state department saying fewer Mainers are using the prescription drugs involved in most of those deaths.


Let’s get one bit of context out of the way before digging in to the details. DHHS, until recently led by former Commissioner Mary Mayhew, trumpeted the “early success” of the opioid law just hours after Mills reminded the public of the extent of Maine’s drug epidemic. Mayhew and Mills both happen to be running for governor in 2018.

Beyond that, these two outcomes aren’t mutually exclusive. While overdoses overall haven’t slowed, the percentage of deaths involving prescription opioids has dipped — to 30 percent during the first half of this year, compared to 33 percent for all of 2016.

What’s really driving overdose deaths is the proliferation of illegal fentanyl, an astoundingly powerful synthetic opioid.

And believe it or not, overdose deaths continuing at the same rate as last year represents a dismal kind of progress. Before now, Maine’s rate of fatal drug deaths had risen every year since 2011. The rest of 2017 has yet to play out, but this data could offer a glimmer of hope.

Maine’s new limits on opioid prescriptions may have played a role in the shrinking share of overdoses involving prescription drugs. Unfortunately DHHS released no actual numbers on showing prescriptions for powerful opioids are falling, so the degree to which that’s happening remains unclear. I asked for the figures, but so far have not received a response.

DHHS also did not respond to my question about whether Maine has seen a corresponding uptick in the number of visits to physical and occupational therapists, and other alternative pain treatment providers. As patients are tapered off these powerful painkillers, the hope is that they’ll have success with other methods of managing their pain.

UPDATE: DHHS responded on Monday afternoon, stating that high-dose opioid prescriptions (equaling more than 300 morphine milligram equivalents) fell nearly 75 percent, from 224 in December 2016 to 59 in July 2017. That’s among MaineCare recipients only, and does not include people with other forms of health insurance.

A spokeswoman also said DHHS “does not collect statewide data regarding visits to alternative pain treatment providers, but continues to promote these alternative treatments for effective pain management.”

Under the law, health providers can prescribe only up to the equivalent of 100 milligrams of morphine per day. Above this threshold, the risk of side effects, addiction, death and diversion of drugs greatly increases, DHHS states.

Medical studies support the effectiveness of opioids for treating acute pain, such as after surgery or an injury, but there’s little evidence to support their use over the long term for chronic pain.

Maine law also requires prescribers to participate in the state Prescription Monitoring Program, a database of controlled drug transactions, and submit opioid prescriptions electronically.

DHHS said it worked closely with lawmakers to ensure appropriate exemptions exist for those who may require higher dosagesCancer and hospice patients, for example, are exceptions.

But some patients say they’ve been stripped of medications they rely on to manage debilitating pain.

“The law has been helpful, but not without quite a bit of struggle on the part of patients, and profound annoyance and interference with prescribers. But it’s probably the right thing,” said Gordon Smith of the Maine Medical Association, which represents physicians. 

Debora Gerrish, 55, of Winter Harbor said she’s desperate for relief after losing her prescription for oxycodone as a result of the law. She took a high dose of the medication for 10 years to manage pain resulting from herniated discs in her back, nerve damage and related health problems.

Without it, everything hurts, Gerrish said: turning her head, reaching with her arms, and constant muscle spasms so intense that they constrict her ribs and ability to breathe. She can’t drive or complete tasks around the house, Gerrish said. 

She’s seen several doctors who failed to read her medical records or the new law, she said, which she believes allows for an exception for her situation.

“They’ve totally abandoned the chronic pain people,” Gerrish said. “What am I supposed to do? It’s not the way anybody wants to live, and they don’t care.”

Gerrish said she supports the law, because people who don’t need the medications shouldn’t become addicted to them. But people like her who truly depend on the drugs for pain relief have been left to suffer, she said.

“I’m hurting constantly all day long,” she said.

Jackie Farwell

About Jackie Farwell

I'm the health editor for the Bangor Daily News, a Bangor native, a UMaine grad, and a weekend crossword warrior. I never get sick of writing about Maine people, geeking out over health care data, and finding new ways to help you stay well. I live in Gorham with my husband Nick and our hound dog Riley.