An Act To Establish Reasonable and Clinically Appropriate Exceptions to Opioid Medication Prescribing Limits
Maine Legislature, Session 128, LD 1031
Committee Amendment CA_A_S242 (Senate)
Amends: 22 MRSA §1726, 22 MRSA §7246, 22 MRSA §7249, 22 MRSA §7250, 22 MRSA §7253, 22 MRSA §7254, 32 MRSA §2210, 32 MRSA §2600-C, 32 MRSA §3300-F, 32 MRSA §3657, 32 MRSA §18308

COMMITTEE AMENDMENT "A" to S.P. 338, L.D. 1031, Bill, "An Act To 
Establish Reasonable and Clinically Appropriate Exceptions to Opioid Medication 
Prescribing Limits" 
Amend the bill by striking out the title and substituting the following: 
'An Act To Clarify the Opioid Medication Prescribing Limits Laws' 
Amend the bill by striking out everything after the title and before the emergency 
clause and inserting the following: 
'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, health care providers need clarification of palliative care and serious 
illness exemptions to the opioid limit of 100 morphine milligram equivalents per day; and 
Whereas, surgical procedures routinely require higher dosages than the current 
opioid limit laws allow and clarification to the law is necessary immediately; 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 §1726, sub-§1, 11A and B, as enacted by PL 2015, c. 203, 
§2, are amended to read: 
A. "Palliative care" means patient-centered and family-focused medical care that 
optimizes quality of life by anticipating, preventing and treating suffering caused by a 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT "A" to S.P. 338, L.D. 1031 
medical illness or a physical injury or condition that substantially affects a patient's 
quality of life, including, but not limited to, addressing physical, emotional, social 
and spiritual needs; facilitating patient autonomy and choice of care; providing access 
to information; discussing the patient's goals for treatment and treatment options, 
including, when appropriate, hospice care; and managing pain and symptoms 
comprehensively. Palliative care does not always include a requirement for hospice 
care or attention to spiritual needs. 
B. 
"Serious illness" means a medical illness or physical injury or condition that 
substantially affects quality of life for more than a short period of time. "Serious 
illness" includes, but is not limited to, Alzheimer's disease and related dementias, 
lung disease, cancer aa4.,_ heart, renal or liver failure and chronic, unremitting or 
intractable pain such as neuropathic pain. 
Sec. 2. 22 MRSA §7246, sub-§2, as enacted by PL 2003, c. 483, §1, is amended 
to read: 
2. Dispenser. "Dispenser" means a pharmacist who is licensed or registered under 
Title 32 or a lioensed health oare professional with al:lthority to dispense or administer 
presoription drugs. 
Sec. 3. 22 MRSA §7249, sub-§1, as amended by PL 2011, c. 657, Pt. AA, §68, is 
further amended to read: 
1. 
Information required. ~ 
Except as provided in subsection 1-A, each 
dispenser shall submit to the department, by electronic means or other format specified in 
a waiver granted by the department, specific items of information regarding dispensed 
controlled substances detennined by the office from the following list: 
A. The dispenser identification number; 
B. The date the prescription was filled; 
C. The prescription number; 
D. Whether the prescription is new or is a refill; 
E. The National Drug Code (NDC) for the drug dispensed; 
F. The quantity dispensed; 
G. The dosage; 
H. The patient identification number; 
I. The patient name; 
J. The patient address; 
K. The patient date of birth; 
L. The prescriber identification number; 
M. The date the prescription was issued by the prescriber; and 
N. The department-issued serial number if the department chooses to establish a 
serial prescription system. 
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COMMITTEE AMENDMENT." A" to S.P. 338, L.D. 1031 
Sec. 4. 22 MRSA §7249, sub-§1-A is enacted to read: 
1-A. Small quantity dispensing. If a controlled substance is dispensed by a hospital 
emergency department to a person receiving care in the emergency department for use by 
that person during a period of 48 hours or less after the controlled substance is dispensed, 
the dispenser is not required to comply with subsection 1. 
Sec. 5. 22 MRSA §7250, sub-§4, 1,i:1 and J, as amended by PL 2017, c. 87, §1, 
are further amended to read: 
I. Staff members of a licensed hospital who are authorized by the chief medical 
officer of the hospital, insofar as the information relates to a patient receiving care in 
the hospital's emergency department or receiving inpatient services or surgical 
services from the hospital; 
J. Staff members of a pharmacist who are authorized by the pharmacist on duty, 
insofar as the information relates to a customer seeking to have a prescription filled; 
aoo 
Sec. 6. 22 MRSA §7250, sub-§4, ,i:I(, as enacted by PL 2017, c. 87, §2, is 
amended to read: 
K. 
The chief medical officer, medical director or other administrative prescriber 
employed by a licensed hospital, insofar as the information relates to prescriptions 
written by prescribers employed by that licensed hospitak and 
Sec. 7. 22 MRSA §7250, sub-§4, ,iL is enacted to read: 
L. 
Staff members of a group practice of prescribers who are authorized by a 
designated group practice leader, insofar as the information relates to a patient 
receiving care from that group practice. 
Sec. 8. 22 MRSA §7253, sub-§2, as enacted by PL 2015, c. 488, §9, is amended 
to read: 
2. Dispensers. On or after January 1, 2017, a dispenser shall check prescription 
monitoring information prior to dispensing a benzodiazepine or an opioid medication to a 
person under any of the following circumstances: 
A. The person is not a resident of this State; 
B. The prescription is from a prescriber with an address outside of this State; 
C. The person is paying cash when the person has prescription insurance on file; or 
D. 
According to the pharmacy prescription record, the person has not had a 
prescription for a benzodiazepine or an opioid medication in the previous 12-month 
period. 
A dispenser shall flotify the pFogram afld withhold a prescription until the dispenser is 
able to contact the prescriber of that prescription if the dispenser has reason to believe 
that the prescription is fraudulent or duplicative. 
Sec. 9. 22 MRSA §7253, sub-§3, as repealed and replaced by PL 2017, c. 122, 
§ 1, is amended to read: 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT" A "to S.P. 338, L.D. 1031 
3. 
Exceptions. 
The requirements to check prescription monitoring information 
established in this section do not apply: 
A. 
When a licensed or certified health care professional directly orders or 
administers 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 or in connection with a surgical procedure; or 
B. When a licensed or certified heath care professional directly orders, prescribes or 
administers a benzodiazepine or opioid medication to a person suffering from pain 
associated with end-of-life or hospice care. 
Sec. 10. 22 MRSA §7253, sub-§5, as enacted by PL 2015, c. 488, §9, is repealed. 
Sec. 11. 22 MRSA §7254, sub-§2, as enacted by PL 2015, c. 488, §9, is amended 
to read: 
2. Rulemaking. Notwithstanding section 7252, no later than January 1, 2017, the 
department shall adopt routine technical rules as defined in Title 5, chapter 375, 
subchapter 2-A to establish reasonable exceptions to prescriber limits in Title 32, sections 
2210, 2600-C, 3300-F, 3657 and 18308, including for chronic pain and acute pain. The 
rules must take into account clinically appropriate exceptions and include prescribers in 
the rule-making process including the drafting of draft rules and changes after the public 
hearing process to the extent permitted by Title 5, chapter 375. After July 1, 2017, any 
rules adopted by the department pursuant to this section are governed by section 7252. 
Sec. 12. 32 MRSA §2210, sub-§1, ,in, as enacted by PL 2015, c. 488, §13, is 
amended to read: 
D. On or after January 1, 2017, within a 7-day period, more than a 7-day supply of 
an opioid medication to a patient under treatment for acute pain unless the opioid 
product is labeled by the federal Food and Drug Administration to be dispensed only 
in a stock bottle that exceeds a 7-day supply as prescribed, in which case the amount 
dispensed may not exceed a 14-day supply. "Acute pain" has the same meaning as in 
Title 22, section 7246, subsection 1-A. 
Sec. 13. 32 MRSA §2210, sub-§2, ~' as enacted by PL 2015, c. 488, §13, is 
amended to read: 
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 or in connection with a surgical procedure. 
As used in this paragraph, "administer" has the same meaning as in Title 22, section 
7246, subsection 1-B. 
Sec. 14. 32 MRSA §2600-C, sub-§1, ,in, as enacted by PL 2015, c. 488, § 17, is 
amended to read: 
D. On or after January 1, 2017, within a 7-day period, more than a 7-day supply of 
an opioid medication to a patient under treatment for acute pain unless the opioid 
product is labeled by the federal Food and Drug Administration to be dispensed only 
in a stock bottle that exceeds a 7-day supply as prescribed, in which case the amount 
COMMITTEE AMENDMENT 
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COMMITTEEAMENDMENT"A "to S.P. 338, L.D. 1031 
dispensed may not exceed a 14-day supply. For purposes of this paragraph, "acute 
pain" has the same meaning as in Title 22, section 7246, subsection 1-A. 
Sec. 15. 32 MRSA §2600-C, sub-§2, ~' as enacted by PL 2015, c. 488, §17, is 
amended to read: 
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 or in connection with a surgical procedure. 
As used in this paragraph, "administer" has the same meaning as in Title 22, section 
7246, subsection 1-B. 
Sec. 16. 32 MRSA §3300-F, sub-§1, ~, as enacted by PL 2015, c. 488, §20, is 
amended to read: 
D. On or after January 1, 2017, within a 7-day period, more than a 7-day supply of 
an opioid medication to a patient under treatment for acute pain unless the opioid 
product is labeled by the federal Food and Drug Administration to be dispensed only 
in a stock bottle that exceeds a 7-day supply as prescribed, in which case the amount · 
dispensed may not exceed a 14-day supply. "Acute pain" has the same meaning as in 
Title 22, section 7246, subsection 1-A. 
Sec. 17. 32 MRSA §3300-F, sub-§2, ~, as enacted by PL 2015, c. 488, §20, is 
amended to read: 
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 or in connection with a surgical procedure. 
As used in this paragraph, "administer" has the same meaning as in Title 22, section 
7246, subsection 1-B. 
Sec. 18. 32 MRSA §3657, sub-§1, ~, as enacted by PL 2015, c. 488, §23, is 
amended to read: 
D. On or after January 1, 2017, within a 7-day period, more than a 7-day supply of 
an opioid medication to a patient under treatment for acute pain unless the opioid 
product is labeled by the federal Food and Drug Administration to be dispensed only 
in a stock bottle that exceeds a 7-day supply as prescribed, in which case the amount 
dispensed may not exceed a 14-day supply. "Acute pain" has the same meaning as in 
Title 22, section 7246, subsection 1-A. 
Sec. 19. 32 MRSA §3657, sub-§2, ~, as enacted by PL 2015, c. 488, §23, is 
amended to read: 
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 or in connection with a surgical procedure. 
As used in this paragraph, "administer" has the same meaning as in Title 22, section 
7246, subsection 1-B. 
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COMMITTEE AMENDMENT" A" to S.P. 338, L.D. 1031 
Sec. 20. 32 MRSA §18308, sub-§1, ,in, as enacted by PL 2015, c. 488, §32, is 
amended to read: 
D. On or after January 1, 2017, within a 7-day period, more than a 7-day supply of 
an opioid medication to a patient under treatment for acute pain unless the opioid 
product is labeled by the federal Food and Drug Administration to be dispensed only 
in a stock bottle that exceeds a 7-day supply as prescribed, in which case the amount 
dispensed may not exceed a 14-day supply. For purposes of this paragraph, "acute 
pain" has the same meaning as in Title 22, section 7246, subsection 1-A. 
Sec. 21. 32 MRSA §18308, sub-§2, ~' as enacted by PL 2015, c. 488, §32, is 
amended to read: 
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 or in connection with a surgical procedure. 
As used in this paragraph, "administer" has the same meaning as in Title 22, section 
7246, subsection 1-B. 
Sec. 22. Department of Health and Human Services to amend rules. The 
Department of Health and Human Services, office of substance abuse and mental health 
services shall amend its rules in Chapter 11, Rules Governing the Controlled Substances 
Prescription Monitoring Program and Prescription of Opioid Medications so that,the rules 
conform to those sections of this Act that amend the Maine Revised Statutes, Title 22, 
section 7246, subsection 2 and section 7253, subsection 2. Rules adopted pursuant to this 
section are routine technical rules as defined in Title 5, chapter 375, subchapter 2-A, 
except that any subsequent amendments to those rules are major substantive rules as 
defined in Title 5, chapter 375, subchapter 2-A.' 
SUMMARY 
This amendment replaces the bill. The amendment makes the following changes to 
the laws relating to the Controlled Substances Prescription Monitoring Program and 
limits on opioid prescribing. 
I . In the laws governing the Palliative Care and Quality of Life Interdisciplinary 
Advisory Council, it changes the definition of "palliative care" to clarify that palliative 
care does not always include a requirement for hospice care or attention to spiritual needs 
and includes chronic, unremitting or intractable pain such as neuropathic pain as an 
example of"serious illness." 
2. It changes the definition of "dispenser" to remove health care professionals. 
3. It removes the requirement to submit to the Department of Health and Human 
Services information regarding a controlled substance that is dispensed by a hospital 
emergency department for use during a period of 48 hours or less. 
4. 
It adds to the list of individuals who can access the Controlled Substances 
Prescription Monitoring Program information the staff members of a group practice of 
prescribers who are authorized by a designated group practice leader, insofar as the 
information relates to a patient receiving care from that group practice. 
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COMMITTEE AMENDMENT "A" to S.P. 338, L.D. 1031 
5. It removes the requirement for a dispenser to notify the Controlled Substances 
Prescription Monitoring Program if the dispenser has reason to believe that a prescription 
is fraudulent or duplicative, maintaining the requirement that the dispenser contact the 
prescriber. 
6. It clarifies that the requirement to check the Controlled Substances Prescription 
Monitoring Program does not apply for surgical procedures, rather than only inpatient 
surgery. 
7. It clarifies that dispensing in connection with surgical procedures is exempt from 
the 100 morphine milligram equivalents limitation on opioids. 
8. It clarifies that an opioid product that is labeled by the federal Food and Drug 
Administration to be dispensed only in a stock bottle that exceeds a 7-day supply may be 
prescribed as long as the amount dispensed does not exceed a 14-day supply. 
9. It makes all rules related to the Controlled Substances Prescription Monitoring 
Program major substantive rules except that the Department of Health and Human 
Services is directed to adopt routine technical rules to conform to the changes in the 
definition of "dispenser" and the removal of the requirement of a pharmacist to notify the 
program when a prescription appears fraudulent or duplicative. 
COMMITTEE AMENDMENT