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EDs Face Myriad of New Laws Limiting Opioid Prescribing

AUGUSTA, ME – Beginning in January, emergency physicians and other prescribers in Maine will have some new limitations on how they can write prescriptions for opioids.

Prescriptions for acute pain will be limited to seven days and to 30 days for chronic pain to prevent diversion and abuse, according to the bill signed into law last spring and going into effect in 2017.

That law is similar to one passed in Pennsylvania this fall, which mandates that ED patients no longer be prescribed more than a week’s worth of opioids, unless practitioners document that there is no alternative to a longer prescription. In addition, ED clinicians won’t be allowed to write refills for opioid prescriptions. Similar restrictions are in effect for urgent care centers and hospital observation units.

Those are just two of several states that have placed dosage limits on opioid prescriptions for patients experiencing non-surgical, acute pain in hopes of curbing the overdose epidemic. How those laws affect emergency physicians’ ability to prescribe opioids varies significantly across state lines.

The limits on opioid prescribing have been promoted by the National Conference of State Legislatures (NCLS), which promotes and tracks such measures. The NCLS offers suggestions on ways states should change policy, initiate programs, or develop partnerships to address drug overdose problems, while ensuring access to prescription drugs for legitimate users.

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Connecticut, Massachusetts, New York, and Rhode Island were among the states also enacting laws to limit the amount of opioids that can be prescribed, while Vermont and Arizona implemented similar supply and dosage limits through rulemaking and executive orders.

Arizona’s governor, for example, signed an executive order to limit initial opioid prescriptions to seven days in the state’s Medicaid system and the state employee insurance program.

At the same time, Maine and Rhode Island use a maximum morphine milligram equivalent (MME) as part of their approaches to limit the amount of opioids that can be prescribed. In Maine, the maximum is 100 MME per day, while Rhode Island has a 30 MME daily maximum and a 20 dose limit for initial opioid prescriptions for adults.

In most states, exceptions exist for cancer care and treatment, palliative care, and hospice care. Pennsylvania even allows exceptions when in the best medical judgment of the provider.

The American Medical Association (AMA) and some other medical groups have opposed the prescribing limits.

“Arbitrary pill limits or dosage limits are not the way to go,” said Patrice Harris, MD, who chairs AMA’s Committee on Opioid Abuse. “They are one-size-fits-all, blunt approaches.”