Kennebec Region Health Alliance

Clinical Implications of PL c. 488
An Act To Prevent Opiate Abuse by Strengthening the Controlled Substances Prescription Monitoring Program

1. What is now mandated?
   1. Checking the PMP with initial prescriptions for opioids or benzodiazepines and every 90 days thereafter
   2. 7 day limit on opioid prescriptions for acute pain, 30 days for chronic pain
   3. Total daily dose not to exceed 100 MME (approx. 65mg of oxycodone daily, 24mg of hydromorphone daily, 100mg of hydrocodone daily, 20mg of methadone daily)
   4. 3 hours of mandated prescriber CME every 2 years
   5. Electronic prescribing
2. Are there exceptions?
   1. Does not apply to cancer diagnoses, substance abuse treatment, hospice care, palliative care
   2. Does not apply to medications administered within a facility
   3. “medical exception” can be documented in the chart until DHHS has written the rules around exceptions (expected by January 1st 2017) – for example, managing acute postoperative pain in a patient already on 100 MME daily chronically
3. When does this begin?
   1. 100 MME limit for new opioid prescriptions: July 29th, 2016
   2. PMP check and limits on duration of prescriptions: January 1st, 2017
   3. Electronic prescribing: July 1st, 2017
   4. Tapering from 300 MME to 100 MME limit for patients currently on high-dose opioids: completed by July 1st, 2017
   5. CME requirements: December 2017
4. What are the consequences for violating the law? (delayed until PMP enhancements completed)
   1. Fines
   2. Disciplinary action by Board
5. PMP improvements
   1. MME dosage converter
   2. Improved speed, improved delegation process
   3. De-identified comparison reports of prescriber to peers