An Act To Establish Reasonable and Clinically Appropriate Exceptions to Opioid Medication Prescribing Limits
Maine Legislature, Session 128, LD 1031
Committee: Health and Human Services
Sponsors: GRATWICK, BERRY, BRAKEY, CUSHING, DILL, VOLK, BROOKS, CHACE, STANLEY, TIPPING
Amends: 22 MRSA §7255, 32 MRSA §2210, 32 MRSA §2600-C, 32 MRSA §3300-F, 32 MRSA §3657, 32 MRSA §18308

Legislative Document
No. 1031
S.P. 338
In Senate, March 14, 2017
An Act To Establish Reasonable and Clinically Appropriate 
Exceptions to Opioid Medication Prescribing Limits
(EMERGENCY)
Reference to the Committee on Health and Human Services suggested and ordered printed.
HEATHER J.R. PRIEST
Secretary of the Senate
Presented by Senator GRATWICK of Penobscot.
Cosponsored by Representative BERRY of Bowdoinham and
Senators: BRAKEY of Androscoggin, CUSHING of Penobscot, DILL of Penobscot, VOLK of 
Cumberland, Representatives: BROOKS of Lewiston, CHACE of Durham, STANLEY of 
Medway, TIPPING of Orono.
Emergency preamble. Whereas, acts and resolves of the Legislature do not 
become effective until 90 days after adjournment unless enacted as emergencies; and 
Whereas, Public Law 2015, chapter 488 enacted a number of changes to the laws 
governing the Controlled Substances Prescription Monitoring Program and the 
prescribing and dispensing of opioid medication and other drugs; and 
Whereas, the law requires that, beginning July 1, 2017, the aggregate amount of 
opioid medication prescribed to a patient may not be in excess of 100 morphine milligram 
equivalents per day; and 
Whereas, health care providers have been working and will continue to work with 
those patients who have been taking medication in excess of this limit to develop a 
tapering plan to reduce their dose to the statutorily required limit by July 2017; and 
Whereas, there exist certain patients who, based on their prior dosage, medical 
history and current function, in their doctors' medical opinions cannot safely have their 
dosages tapered by the deadline established in the law; and 
Whereas, it is essential that for these individuals there be a system in place to 
provide to health care providers, on a case-by-case basis, the ability for a specified period 
to prescribe doses in excess of 100 morphine milligram equivalents per day; and 
Whereas, in the judgment of the Legislature, these facts create an emergency within 
the meaning of the Constitution of Maine and require the following legislation as 
immediately necessary for the preservation of the public peace, health and safety; now, 
therefore, 
Be it enacted by the People of the State of Maine as follows: 
Sec. 1.  22 MRSA §7255 is enacted to read: 
§7255.  Prescription exceeding opioid medication limits; medical necessity 
In addition to the exceptions set forth in Title 32, sections 2210, 2600-C, 3300-F, 
3657 and 18308, a prescriber in accordance with this section may prescribe, based on 
medical necessity, opioid medication in an amount greater than the morphine milligram 
equivalents limits set out in Title 32, sections 2210, 2600-C, 3300-F, 3657 and 18308. 
1.  Documentation of medical necessity.  If, in the prescriber's judgment, it is 
medically necessary to prescribe opioid medication in an amount greater than the 
morphine milligram equivalents limits set out in Title 32, sections 2210, 2600-C, 3300-F, 
3657 and 18308, a prescriber shall document that medical necessity in accordance with 
this subsection, and in the patient's medical records shall: 
A.  Specify the medical necessity of opioid dosing greater than 100 morphine 
milligram equivalents per day; 
B.  Confirm that an appropriate pain history and physical examination have been 
completed and documented; 
C.  Confirm the failure of the following alternative treatments: 
(1)  Nonsteroidal anti-inflammatory drugs; 
(2)  Adjunctive medicines, including antidepressants and anticonvulsants; 
(3)  Physical therapy, occupational therapy or exercise; 
(4)  Cognitive behavioral therapy or acceptance and commitment therapy; and 
(5)  Counseling and treatment regarding lifestyle changes, including diet and 
smoking cessation; 
D.  Confirm that a taper trial resulted in significant loss of function and that larger 
doses are necessary; 
E.  Confirm the use of an opioid risk assessment tool and document the management 
of opioid risk, including: 
(1)  If the patient has a substance use disorder or alcohol use disorder, 
documentation of a substance use disorder or alcohol use disorder treatment plan; 
and 
(2)  Compliance with section 7253, subsection 1; 
F.  Confirm that a patient-provider controlled medication agreement is completed 
annually and is on file with the prescriber; 
G.  Confirm that patient documentation of informed consent is completed annually 
and is on file with the prescriber; and 
H.  Confirm that random urine drug testing demonstrates appropriate use by the 
patient. 
Sec. 2.  32 MRSA §2210, sub-§2, as enacted by PL 2015, c. 488, §13, is amended 
to read: 
2.  Exceptions.  An individual licensed under this chapter whose scope of practice 
includes prescribing opioid medication is exempt from the limits on opioid medication 
prescribing established in subsection 1 only: 
A.  When prescribing opioid medication to a patient for: 
(1)  Pain For pain associated with active and aftercare cancer treatment; 
(2)  Palliative For palliative care, as defined in Title 22, section 1726, subsection 
1, paragraph A, in conjunction with a serious illness, as defined in Title 22, 
section 1726, subsection 1, paragraph B; 
(3)  End-of-life For end-of-life and hospice care; 
(4)  Medication-assisted For medication-assisted treatment for substance use 
disorder; or 
(5)  Other circumstances determined in rule by the Department of Health and 
Human Services pursuant to Title 22, section 7254, subsection 2; and 
(6)  For postoperative or new-onset acute pain when the patient has an existing 
opioid prescription for chronic pain; 
(7)  Pursuing an active taper of opioid medications, with a maximum taper period 
of 6 months; 
(8)  Who is pregnant and who has a preexisting prescription for opioids in excess 
of the limit. This exemption applies only during the duration of the pregnancy; or 
(9)  That is medically necessary, in the prescriber's judgment, and the prescriber 
has documented that medical necessity in accordance with Title 22, section 7255; 
and 
B.  When directly ordering or administering a benzodiazepine or opioid medication to 
a person in an emergency room setting, an inpatient hospital setting, a long-term care 
facility or a residential care facility. 
As used in this paragraph, "administer" has the same meaning as in Title 22, section 
7246, subsection 1-B. 
Sec. 3.  32 MRSA §2600-C, sub-§2, as enacted by PL 2015, c. 488, §17, is 
amended to read: 
2.  Exceptions.  An individual licensed under this chapter whose scope of practice 
includes prescribing opioid medication is exempt from the limits on opioid medication 
prescribing established in subsection 1 only: 
A.  When prescribing opioid medication to a patient for: 
(1)  Pain For pain associated with active and aftercare cancer treatment; 
(2)  Palliative For palliative care, as defined in Title 22, section 1726, subsection 
1, paragraph A, in conjunction with a serious illness, as defined in Title 22, 
section 1726, subsection 1, paragraph B; 
(3)  End-of-life For end-of-life and hospice care; 
(4)  Medication-assisted For medication-assisted treatment for substance use 
disorder; or 
(5)  Other circumstances determined in rule by the Department of Health and 
Human Services pursuant to Title 22, section 7254, subsection 2; and 
(6)  For postoperative or new-onset acute pain when the patient has an existing 
opioid prescription for chronic pain; 
(7)  Pursuing an active taper of opioid medications, with a maximum taper period 
of 6 months; 
(8)  Who is pregnant and who has a preexisting prescription for opioids in excess 
of the limit. This exemption applies only during the duration of the pregnancy; or 
(9)  That is medically necessary, in the prescriber's judgment, and the prescriber 
has documented that medical necessity in accordance with Title 22, section 7255; 
and 
B.  When directly ordering or administering a benzodiazepine or opioid medication to 
a person in an emergency room setting, an inpatient hospital setting, a long-term care 
facility or a residential care facility. 
As used in this paragraph, "administer" has the same meaning as in Title 22, section 
7246, subsection 1-B. 
Sec. 4.  32 MRSA §3300-F, sub-§2, as enacted by PL 2015, c. 488, §20, is 
amended to read: 
2.  Exceptions.  An individual licensed under this chapter whose scope of practice 
includes prescribing opioid medication is exempt from the limits on opioid medication 
prescribing established in subsection 1 only: 
A.  When prescribing opioid medication to a patient for: 
(1)  Pain For pain associated with active and aftercare cancer treatment; 
(2)  Palliative For palliative care, as defined in Title 22, section 1726, subsection 
1, paragraph A, in conjunction with a serious illness, as defined in Title 22, 
section 1726, subsection 1, paragraph B; 
(3)  End-of-life For end-of-life and hospice care; 
(4)  Medication-assisted For medication-assisted treatment for substance use 
disorder; or 
(5)  Other circumstances determined in rule by the Department of Health and 
Human Services pursuant to Title 22, section 7254, subsection 2; and 
(6)  For postoperative or new-onset acute pain when the patient has an existing 
opioid prescription for chronic pain; 
(7)  Pursuing an active taper of opioid medications, with a maximum taper period 
of 6 months; 
(8)  Who is pregnant and who has a preexisting prescription for opioids in excess 
of the limit. This exemption applies only during the duration of the pregnancy; or 
(9)  That is medically necessary, in the prescriber's judgment, and the prescriber 
has documented that medical necessity in accordance with Title 22, section 7255; 
and 
B.  When directly ordering or administering a benzodiazepine or opioid medication to 
a person in an emergency room setting, an inpatient hospital setting, a long-term care 
facility or a residential care facility. 
As used in this paragraph, "administer" has the same meaning as in Title 22, section 
7246, subsection 1-B. 
Sec. 5.  32 MRSA §3657, sub-§2, as enacted by PL 2015, c. 488, §23, is amended 
to read: 
2.  Exceptions.  An individual licensed under this chapter whose scope of practice 
includes prescribing opioid medication is exempt from the limits on opioid medication 
prescribing established in subsection 1 only: 
A.  When prescribing opioid medication to a patient for: 
(1)  Pain For pain associated with active and aftercare cancer treatment; 
(2)  Palliative For palliative care, as defined in Title 22, section 1726, subsection 
1, paragraph A, in conjunction with a serious illness, as defined in Title 22, 
section 1726, subsection 1, paragraph B; 
(3)  End-of-life For end-of-life and hospice care; 
(4)  Medication-assisted For medication-assisted treatment for substance use 
disorder; or 
(5)  Other circumstances determined in rule by the Department of Health and 
Human Services pursuant to Title 22, section 7254, subsection 2; and 
(6)  For postoperative or new-onset acute pain when the patient has an existing 
opioid prescription for chronic pain; 
(7)  Pursuing an active taper of opioid medications, with a maximum taper period 
of 6 months; 
(8)  Who is pregnant and who has a preexisting prescription for opioids in excess 
of the limit. This exemption applies only during the duration of the pregnancy; or 
(9)  That is medically necessary, in the prescriber's judgment, and the prescriber 
has documented that medical necessity in accordance with Title 22, section 7255; 
and 
B.  When directly ordering or administering a benzodiazepine or opioid medication to 
a person in an emergency room setting, an inpatient hospital setting, a long-term care 
facility or a residential care facility. 
As used in this paragraph, "administer" has the same meaning as in Title 22, section 
7246, subsection 1-B. 
Sec. 6.  32 MRSA §18308, sub-§2, as enacted by PL 2015, c. 488, §32, is 
amended to read: 
2.  Exceptions.  An individual licensed under this chapter whose scope of practice 
includes prescribing opioid medication is exempt from the limits on opioid medication 
prescribing established in subsection 1 only: 
A.  When prescribing opioid medication to a patient for: 
(1)  Pain For pain associated with active and aftercare cancer treatment; 
(2)  Palliative For palliative care, as defined in Title 22, section 1726, subsection 
1, paragraph A, in conjunction with a serious illness, as defined in Title 22, 
section 1726, subsection 1, paragraph B; 
(3)  End-of-life For end-of-life and hospice care; 
(4)  Medication-assisted For medication-assisted treatment for substance use 
disorder; or 
(5)  Other circumstances determined in rule by the Department of Health and 
Human Services pursuant to Title 22, section 7254, subsection 2; and 
(6)  For postoperative or new-onset acute pain when the patient has an existing 
opioid prescription for chronic pain; 
(7)  Pursuing an active taper of opioid medications, with a maximum taper period 
of 6 months; 
(8)  Who is pregnant and who has a preexisting prescription for opioids in excess 
of the limit. This exemption applies only during the duration of the pregnancy; or 
(9)  That is medically necessary, in the prescriber's judgment, and the prescriber 
has documented that medical necessity in accordance with Title 22, section 7255; 
and 
B.  When directly ordering or administering a benzodiazepine or opioid medication to 
a person in an emergency room setting, an inpatient hospital setting, a long-term care 
facility or a residential care facility. 
As used in this paragraph, "administer" has the same meaning as in Title 22, section 
7246, subsection 1-B. 
Emergency clause.  In view of the emergency cited in the preamble, this 
legislation takes effect when approved. 
SUMMARY 
Public Law 2015, chapter 488 requires that, beginning July 1, 2017, the aggregate 
amount of opioid medication prescribed to a patient may not be in excess of 100 
morphine milligram equivalents per day and directs the Department of Health and Human 
Services to adopt rules establishing reasonable exceptions to those prescriber limits.  This 
bill codifies in statute the exceptions adopted in the department's rules and adds an 
exception to prescribing limits for medical necessity.