An Act To Reduce Opioid Overprescription, Overuse and Abuse
Maine Legislature, Session 125, LD 1501
Committee: Health and Human Services
Sponsors: HINCK, CRAVEN, EVES, FOSSEL, HASKELL, LUCHINI, PLUMMER, SANBORN, STRANG BURGESS

Legislative Document 
No. 1501 
H.P. 1102 
House of Representatives, April 20, 2011 
An Act To Reduce Opioid Overprescription, Overuse and Abuse 
Received by the Clerk of the House on April 15, 2011.  Referred to the Committee on 
Health and Human Services pursuant to Joint Rule 308.2 and ordered printed pursuant to Joint 
Rule 401. 
HEATHER J.R. PRIEST 
Clerk 
Presented by Representative HINCK of Portland. 
Cosponsored by Senator CRAVEN of Androscoggin and 
Representatives: EVES of North Berwick, FOSSEL of Alna, HASKELL of Portland, 
LUCHINI of Ellsworth, McFADDEN of Dennysville, PLUMMER of Windham, SANBORN 
of Gorham, STRANG BURGESS of Cumberland. 
Be it enacted by the People of the State of Maine as follows: 
Sec. 1.  22 MRSA c. 255-A is enacted to read: 
CHAPTER 255-A 
OPIOID PRESCRIPTION FOR CHRONIC NONCANCER PAIN 
§1411.  Treatment of chronic noncancer pain 
This section applies to the prescribing of opioid drugs for chronic noncancer pain.  
This section does not apply to the prescribing of opioid drugs for the management of 
acute pain or for the provision of palliative care, hospice care or other end-of-life care. 
1.  Definitions.  As used in this section, unless the context otherwise indicates, the 
following terms have the following meanings. 
A.  "Acute pain" means the normal, predicted physiological response to a noxious 
chemical, thermal or mechanical stimulus, generally limited in time to less than 6 
months and typically associated with invasive medical procedures, trauma or disease. 
B.  "Addiction" means a primary, chronic, neurobiological disease with genetic, 
psychosocial and environmental factors influencing its development and 
manifestations that is characterized by behaviors that include impaired control over 
drug use, craving and compulsive use that is continued despite the risk of harm. 
C.  "Chronic noncancer pain" means pain that is not the result of the disease of cancer 
or its manifestations and that persists beyond the usual course of recovery from an 
illness or healing from an injury or pain that causes continuous or intermittent pain 
over many months or years. 
D.  "Comorbidity" means a preexisting or coexisting physical or psychiatric disease 
or condition. 
E.  "Health care provider" or "provider" means a provider of health care who is 
licensed by the State and who is authorized to prescribe drugs by the State and by the 
United States Department of Justice, Drug Enforcement Administration. 
F.  "Hospice care" means a model of care that focuses on relieving symptoms and 
supporting patients with a life expectancy of 6 months or less and that is provided 
through a multidisciplinary approach to health care, pain management and emotional 
and spiritual support. 
G.  "Opioid drug" means a drug that binds to opioid receptors found principally in the 
central nervous system and gastrointestinal tract. 
H.  "Pain management specialist" means: 
(1)  A physician who is board certified or board eligible in physical medicine, 
rehabilitation, 
rehabilitation 
medicine, 
neurology, 
rheumatology 
or 
anesthesiology, has a subspecialty certificate in pain medicine from the 
appropriate allopathic medical board or has a certification of added qualification 
in pain management from the appropriate osteopathic medical board.  For the 
purposes of this subparagraph, "board" for an allopathic physician means the 
American Board of Medical Specialties or its successor and for an osteopathic 
physician means the American Osteopathic Association or its successor; or 
(2)  An advanced practice registered nurse who: 
(a)  Has at least 3 years of clinical experience in a chronic pain management 
care setting; 
(b)  Is credentialed in a specialty that includes a focus on chronic noncancer 
pain management by a national professional association in the field of pain 
management or quality assurance; 
(c)  Has successfully completed in the last 2 years at least 18 hours of 
continuing education in pain management; and 
(d)  Devotes at least 30% of the advanced practice registered nurse's current 
practice to the direct provision of pain management care. 
I.  "Palliative care" means a model of care that improves the quality of life of a 
patient who suffers from a life-threatening illness and the quality of life of the 
patient's family with an emphasis on psychological, spiritual and emotional support 
through attention to prevention, assessment and treatment of pain and other 
symptoms. 
2.  Requirements.  The following requirements apply to the prescribing of opioid 
drugs for a patient with chronic noncancer pain. 
A.  Prior to prescribing an opioid drug for chronic noncancer pain, a health care 
provider shall obtain, evaluate and document in the patient's health record the 
patient's health history, including but not limited to current and past treatments for 
pain, comorbidities, substance use and abuse and a review of information available 
from a pharmacist and from the Controlled Substances Prescription Monitoring 
Program under section 7248, and shall perform a physical examination. 
(1)  In performing the physical examination and evaluating the patient's health 
history, the health care provider shall evaluate the nature and intensity of the 
reported pain and the effect of the pain on physical and psychological function. 
(2)  The health care provider shall review available diagnostic, therapeutic and 
laboratory results and consultations.  The health care provider shall evaluate 
medications taken by the patient, including indications, date, type, dosage and 
quantity prescribed, and shall screen the patient for risk for potential 
comorbidities using an appropriate screening tool that addresses: 
(a)  History of addiction; 
(b)  Abuse or aberrant behavior regarding opioid use; 
(c)  Psychiatric conditions; 
(d)  Regular concomitant use of alcohol or benzodiazepines or other central 
nervous system medications; 
(e)  Poorly controlled depression or anxiety; 
(f)  Evidence or risk of significant adverse events, including falls or fractures; 
(g)  History of sleep apnea or other respiratory risk factors; 
(h)  History of allergies or intolerances to prescription and nonprescription 
drugs, foods and environmental factors; 
(i)  Pregnancy and the possibility of pregnancy; 
(j)  Repeated visits to emergency departments in hospitals seeking access to 
opioid drugs; and 
(k)  Receipt of prescriptions for opioid drugs from more than one health care 
provider or provider group. 
(3)  The health care provider shall maintain a health record that is easily 
accessible and available for review that includes the health care provider's 
diagnosis and the treatment plan required under subparagraph (4), documentation 
of any recognized indications for the use of pain medications, documentation of 
medications prescribed, results of periodic reviews,  documentation of the health 
care provider's instructions to the patient and a copy of the written agreement 
between the health care provider and the patient under paragraph D, if applicable. 
(4)  The health care provider shall develop and maintain a treatment plan for the 
patient that states the objectives of the treatment to be provided and that will be 
used to determine treatment success.  The treatment plan must be used to 
document any relief from pain, any change in physical and psychosocial function 
and any additional diagnostic evaluations and other planned treatments.  The 
treatment plan must include any additional treatment modalities or rehabilitation 
programs as appropriate for the patient, depending on the etiology of the pain and 
the extent to which the pain is associated with physical and psychosocial 
impairment. 
B.  Prior to prescribing an opioid drug for chronic noncancer pain, a health care 
provider shall discuss the risks and benefits of treatment options with the patient.  If 
the patient designates another person to speak with the health care provider or if the 
patient lacks health care decision-making capacity, the health care provider shall 
conduct this discussion of risks and benefits with the person designated by the patient 
or with the patient's guardian or surrogate. 
C.  A health care provider may not knowingly prescribe an opioid drug for chronic 
noncancer pain for a patient who is under the care of another health care provider and 
who has received a prescription for an opioid drug from that health care provider 
except in instances of emergency care or where a health care provider is covering for 
or assisting the prescribing provider or there has been a transfer of care. 
D.  A health care provider may prescribe an opioid drug for chronic noncancer pain 
for a patient who has a history of substance abuse or psychiatric comorbidities or who 
is judged by the health care provider to be at high risk for medication abuse if, prior 
to the issuance of the prescription, the health care provider and patient enter into a 
written agreement for treatment as provided in this paragraph. 
(1)  The health care provider must commit to providing urine or serum screening 
on an ongoing basis during the course of treatment. 
(2)  The patient must commit to: 
(a)  Undergoing urine or serum screening on an ongoing basis during the 
course of treatment; 
(b)  Taking the opioid drug at the prescribed dose and frequency and 
following a specified protocol for lost prescriptions and early refills; 
(c)  Not abusing alcohol or other medically unauthorized substances; 
(d)  Agreeing to the release of the agreement for treatment to hospital 
emergency departments, urgent care facilities and pharmacies and other 
health care providers for treatment purposes, to other health care providers to 
report a violation of the agreement and to law enforcement if the health care 
provider reasonably believes that the patient has engaged in illegal activities; 
and 
(e)  Taking responsibility for the security of the opioid drug, safeguarding it 
and storing it in a safe place. 
(3)  The agreement must specify that: 
(a)  All chronic pain management prescriptions must be written by a single 
health care provider and dispensed by a specific named pharmacy, except 
that the patient may notify the health care provider and change to a new 
pharmacy; 
(b)  Photographic identification is required and a record must be kept of the 
person picking up the opioid drug at the pharmacy; and 
(c)  The agreed-upon drug therapy must be tapered off or discontinued if the 
patient fails to abide by the terms of the agreement and that the reason for the 
tapering off or termination must be entered into the patient's health record 
and treatment plan under paragraph A. 
E.  A health care provider who prescribes an opioid drug for chronic noncancer pain 
shall conduct periodic reviews of the patient's health, the course of treatment and any 
new etiology of the pain as provided in this paragraph. 
(1)  Except as provided in subparagraph (2), periodic review must take place at 
least every 6 months. 
(2)  For patients with a stable medical condition and nonescalating dosages of 40 
milligrams of a morphine equivalent dose or less, periodic review must take place 
at least annually. 
(3)  During the periodic review, the health care provider shall determine the 
patient's compliance with the treatment plan under paragraph A, based on 
information available to the health care provider, including whether pain, 
function or quality of life has improved or diminished under the course of 
treatment, and, based on the health care provider's evaluation of progress, 
whether continuation or modification of the opioid drug is necessary to achieve 
treatment objectives. 
(4)  If the patient's progress or compliance with the treatment plan is 
unsatisfactory to the health care provider, the provider shall consider tapering the 
dose or changing or discontinuing the prescribed drug when function or pain has 
not improved, there is evidence of significant adverse effects, other treatment 
modalities are indicated or there is evidence of misuse, addiction or diversion. 
(5)  If the health care provider determines it to be appropriate for the patient, 
based on information that the provider obtains in the course of treatment or 
during the periodic review, the provider shall adjust the drug therapy. 
F.  A health care provider who prescribes an opioid drug for chronic noncancer pain 
shall include indications for medical use on the prescription and shall require 
photographic identification of the person picking up the prescription drug at the 
pharmacy. 
G.  A health care provider who prescribes an opioid drug for chronic noncancer pain 
shall periodically review available information relating to the patient from 
pharmacists, hospital emergency departments and the Controlled Substances 
Prescription Monitoring Program established under section 7248. 
H.  A health care provider may prescribe opioid drugs for episodic care such as 
emergency or urgent care in accordance with this paragraph. 
(1)  The health care provider shall review any available information relating to 
the patient from a pharmacist, a hospital emergency department or the Controlled 
Substances Prescription Monitoring Program established under section 7248. 
(2)  The health care provider shall limit the prescription of opioid drugs for 
chronic noncancer pain to the minimum necessary to control the pain until the 
patient is able to receive care from a primary care health care provider. 
(3)  The health care provider shall include in the prescription indications for use 
or the code of a recognized international classification of disease and shall 
require photographic identification of the person picking up the opioid drug at the 
pharmacy. 
(4)  Except during treatment in an emergency room or urgent care center, prior to 
the health care provider's prescribing the opioid drug, the health care provider 
and patient shall enter into an agreement for treatment as provided in paragraph 
D. A health care provider who prescribes opioid drugs in an emergency room or 
urgent care center shall whenever possible communicate facts and circumstances 
of the opioid treatment to the patient's primary care physician. 
I.  Referrals to pain management specialists are subject to the provisions of this 
paragraph. 
(1)  Prior to prescribing an opioid drug for chronic noncancer pain, a health care 
provider may refer a patient to a pain management specialist for a consultation 
consisting of an office visit in person by the patient to the pain management 
specialist or a consultation by audio-visual electronic means if the patient is 
accompanied by a health care provider and a telephone consultation between the 
pain management specialist and the health care provider or the electronic transfer 
between them of information resulting from the consultation. 
(2)  Prior to prescribing the opioid drug, a health care provider shall refer a 
patient to a pain management specialist for a consultation if the provider is 
considering prescribing an opioid drug at or above 120 milligrams of a morphine 
equivalent dosage per day unless an exemption provided in paragraph K or L 
applies.  The health care provider who refers a patient for a consultation under 
this subparagraph shall document the referral in the patient's health record and 
shall include in the record any written report from the pain management 
specialist.  A pain management specialist who provides a consultation for a 
health care provider under this subparagraph shall maintain a health record for 
the patient and document the consultation in that record. 
(3)  Prior to prescribing the opioid drug, a health care provider shall consider 
referring a patient to a pain management specialist for a consultation if the patient 
is under 18 years of age or is at risk for medication misuse, abuse or diversion. 
(4)  Nothing in this paragraph restricts the right of a person, the State, a 
municipality, a corporation or other entity to require consultation with a pain 
management specialist prior to the prescribing of an opioid drug for chronic 
noncancer pain. 
J.  A health care provider may prescribe a long-acting opioid drug, including but not 
limited to methadone, for chronic noncancer pain only if the provider has completed 
at least 4 hours of continuing education related to prescription drug treatments for 
chronic noncancer pain, undertakes the necessary careful monitoring of the patient 
and gives special attention to patients who are initiating the treatment. 
K.  Consultation under paragraph I, subparagraph (2) is not required if all of the other 
requirements of this section are met and if: 
(1)  The patient is following a tapering dosage schedule; 
(2)  The patient requires treatment for acute pain, requiring a temporary 
escalation in opioid dosage with expected return to the baseline dosage or below 
that dosage; 
(3)  The circumstances justify prescribing at or above the 120-milligram 
morphine equivalent dosage and the health care provider documents reasonable 
attempts to obtain a consultation; or 
(4)  The health care provider documents that the patient's pain and function are 
stable and that the patient is on a nonescalating dosage of opioid drugs. 
L.  Consultation under paragraph I, subparagraph (2) is not required if the health care 
provider: 
(1)  Is a pain management specialist; 
(2)  Has successfully completed within the last 2 years at least 12 hours of 
continuing education on chronic pain management approved by a nationally 
recognized professional organization on pain management with at least 2 hours 
devoted to long-acting opioids, including methadone; 
(3)  Is a pain management practitioner working in a multidisciplinary chronic 
pain treatment center or an academic research facility; or 
(4)  Has at least 3 years of clinical experience in a chronic pain management 
setting and devotes at least 30% of the health care provider's practice to the direct 
provision of pain management care. 
Sec. 2.  Review.  The Department of Health and Human Services shall review and 
evaluate the efficacy of comprehensive pain management, including physical therapy and 
cognitive behavioral therapy, and report back to the Joint Standing Committee on Health 
and Human Services no later than December 7, 2011. 
SUMMARY 
This bill establishes protocols for the health care provider community to follow in  
prescribing opioid drugs for chronic noncancer pain.  It includes provisions on physical 
examinations, health records, periodic review of patient health and consultations with and 
referrals to pain management specialists. It requires the Department of Health and Human 
Services to review and evaluate the efficacy of comprehensive pain management, 
including physical therapy and cognitive behavioral therapy, and report back to the Joint 
Standing Committee on Health and Human Services no later than December 7, 2011.