Re: Maine narcotic regulations/FOUND IT.

[Guest guest]

Margret :

Here is the Maine state law on treating intractable pain. I have the link below

and also copied, pasted the page below the link. Hope this helps, can your

current doctor refer you to a doctor there in Maine to continue the treatment

you're on now, might ask him he may have better luck in getting you into a

doctor when you move.

Rhonda~n~MS

spark53@...

rballard53@...

http://www.medsch.wisc.edu/painpolicy/domestic/membreg.htm

MAINE

Agency 02. Department of Professional and Financial Regulation

Sub-Agency 373. Board of Licensure in Medicine

Chapter 011. Use of Controlled Substances for Treatment of Pain

Chapter 11: USE OF CONTROLLED SUBSTANCES FOR TREATMENT OF PAIN

Preamble: The Boards recognize that principles of quality medical practice

dictate that the people of the State of Maine have access to appropriate and

effective pain relief.

The Boards acknowledge that controlled substances, including opioid analgesics,

may be essential in the treatment of acute pain due to trauma or surgery, and

chronic pain, whether due to cancer or non-cancer origins. Fears of

investigation by federal, state and local regulatory agencies should not

preclude appropriate and adequate treatment of chronic pain patients. However,

the Boards recognize that inappropriate prescribing of controlled substances,

including opioid analgesics, may lead to drug diversion and abuse by individuals

who seek them for other than legitimate medical use.

The Boards encourage physicians to view effective pain management as a part of

quality medical practice for all patients with pain, acute or chronic, and as

especially important for patients who experience pain as a result of a terminal

illness. All physicians should become knowledgeable about effective methods of

pain treatment as well as statutory requirements for prescribing controlled

substances.

Accordingly, the Boards adopt these rules to clarify their positions on pain

control and prescribing, specifically related to the use of controlled

substances, to alleviate physician uncertainty and to encourage better pain

management.

§ 1. Definitions: As used by the Boards when evaluating practice and prescribing

issues.

A. " Acute Pain " is the normal, predicted physiological response to an adverse

chemical, thermal, or mechanical stimulus and is associated with surgery, trauma

and acute illness. It is generally time limited and is responsive to controlled

substances therapy, among other therapies.

B. " Addiction " is a neurobehavioral syndrome with genetic and environmental

influences that results in psychological dependence on the use of substances for

their psychic effects and is characterized by compulsive use despite harm.

Addiction may also be referred to by terms such as " drug dependence " and

" psychological dependence. " Physical dependence and tolerance are normal

physiological consequences of extended opioid therapy for pain and should not be

considered addiction.

C. " Analgesic Tolerance " is the need to increase the dose of controlled

substances to achieve the same level of analgesia. Analgesic tolerance may or

may not be evident during opioid treatment and does not equate with addiction.

D. " Chronic Pain " is a pain state which is persistent and in which the cause of

the pain cannot be removed or otherwise treated. Chronic pain may be associated

with a long-term incurable or intractable medical condition or disease.

E. " Pain " is an unpleasant sensory and emotional experience associated with

actual or potential tissue damage or described in terms of such damage.

F. " Physical Dependence " on a controlled substance is a physiologic state of

neuroadaptation which is characterized by the emergence of a withdrawal syndrome

if drug use is stopped or decreased abruptly, or an antagonist is administered.

Physical dependence is an expected result of opioid use. Physical dependence, by

itself, does not equate with addiction.

G. " Pseudoaddiction " is a pattern of drug-seeking behavior of pain patients who

are receiving inadequate pain management that can be mistaken for addiction.

H. " Substance Abuse " is the use of any controlled substance(s) for

non-therapeutic purposes; or use of medication for purposes other than those for

which it is prescribed.

I. " Tolerance " is a physiologic state resulting from regular use of a drug in

which an increased dosage is needed to produce the same effect or a reduced

effect is observed with a constant dose.

§ 2. Principles of Proper Patient Management: Each of these principles is

essential in the treatment of patients with pain.

A. Evaluation of the Patient: Evaluation should initially include a pain history

and assessment of the impact of pain on the patient, a directed physical

examination, a review of previous diagnostic studies, a review of previous

interventions, a drug history, and an assessment of coexisting diseases or

conditions.

B. Treatment Plan: Treatment planning should be tailored to both the individual

and the presenting problem. Consideration should be given to different treatment

modalities, such as a formal pain rehabilitation program, the use of behavioral

strategies, the use of non-invasive techniques, or the use of medications,

depending upon the physical and psychosocial impairment related to the pain. If

a trial of controlled substances is selected, the physician should ensure that

the patient or the patient's legally authorized representative is informed of

the risks and benefits of controlled substance use and the conditions under

which controlled substances will be prescribed. Some practitioners find a

written agreement specifying these conditions to be useful. A controlled

substances trial should not be done in the absence of a complete assessment of

the pain complaint.

If the evaluation cannot be completed at the initial visit, controlled

substances should only be prescribed in limited quantities, until completion of

the evaluation, using the best judgment of the prescribing practitioner based on

the information available.

In the instance of chronic end of life pain, please see Section 3.

C. Informed Consent and Agreement for Treatment: The physician should discuss

treatment with the patient, persons designated by the patient, or with the

patient's legally authorized representative if the patient is incompetent. The

patient should receive prescriptions from one physician and one pharmacy, where

possible. If the patient is determined to be at high risk for medication abuse

or has a history of substance abuse, the physician may employ the use of a

written agreement between physician and patient outlining patient

responsibilities. Suggested elements of such an agreement are provided in

Appendix 1.

D. Consultation: The physician should be willing to refer the patient as

necessary for additional evaluation and treatment in order to achieve treatment

objectives. Special attention should be given to those pain patients who are at

risk for misusing their medications and those whose living arrangements pose a

risk for medication misuse or diversion. The management of pain in patients with

a history of substance abuse or with a co-morbid psychiatric disorder may

require extra care, monitoring, documentation, and consultation with or referral

to an expert in the management of such patients.

E. Periodic review of treatment efficacy: Review of treatment efficacy should

occur periodically to assess the functional status of the patient, continued

analgesia, controlled substances side effects, quality of life and indications

of medications abuse. Periodic re-examination is warranted to assess the nature

of the pain complaint and to ensure that controlled substances therapy is still

indicated. Attention should be given to the possibility of a decrease in global

function or quality of life as a result of controlled substance abuse.

F. Documentation: Documentation is essential for supporting the evaluation, the

reason for controlled substance prescribing, the overall pain management

treatment plan, any consultations received, and periodic review of the status of

the patient. The physician should document drug treatment outcomes and rationale

for changes.

Every prescription must be clearly documented in the patient record. All written

prescriptions must include name, address, drug name, amount prescribed, as well

as instructions.

G. Reportable Acts: Information gained as part of the doctor/patient

relationship, even if it gives knowledge of possible criminal acts, remains part

of the confidential doctor/patient relationship. This needs to be contrasted

with persons who use the physician to perpetrate illegal acts such as illegal

acquisition or selling of drugs, etc. The physician has an obligation to deal

with this behavior up to and including reporting to law enforcement. Reports

from other providers, such as pharmacists and ER physicians, suggesting

inappropriate or drug-seeking behavior, should be dealt with appropriately.

§ 3. The Principles of End of Life Pain Therapy:

In the instance of chronic end of life pain, a treatment plan which addresses

the goals of comfort and personal dignity, developed at the time of original

diagnosis is sufficient. Certain suggestions and considerations as noted in

Section 2.2, 3, 4, & 5 may well not apply to this category of patient.

Evaluation and documentation to ensure patient comfort and dignity as well as to

manage other aspects of the underlying illness are expected to continue.

Appendix 1.

1. Controlled Substances Contract: Suggested elements of a controlled substance

contract are as follows:

a) specifies that the physician is the single source of controlled

substances;

may specify the pharmacy;

c) written, informed consent to release contract to local emergency

departments and pharmacies;

d) if written consent is given for release to local emergency departments

and/or pharmacies, consent is also being given to the other providers to report

violations of the contract back to the physician,

e) specifies that if the physician becomes concerned that there has been

illegal activity, the physician may notify the proper authorities;

f) if the physician has obtained a written release, ER personnel and other

providers shall report violations of the contract back to the doctor who

prescribed the controlled substance(s).

g) specifies that a violation of the contract will result in a tapering and

discontinuation of the narcotics prescription;

h) specifies that a risk of chronic narcotics treatment is physical

dependence (as defined);

i) specifies that a risk of chronic narcotics treatment is addiction (as

defined);

j) specifies that it is the responsibility of the patient to be discreet

about possessing narcotics and keeping medications in an inaccessible place so

that they may not be stolen;

k) if the patient violates the terms of the contract, the violation should

be documented. The physician response to the violation should be documented, as

well as the rationale of and changes in the treatment plan.

l) Physician may consider " fill only at ___ pharmacy " on the prescription

form.

32 M.R.S.A. §§ 2562 and 3269(3) and (7)

NOTES: Effective Date: March 22, 1999 (Secretary of State Rule Log #s 99-124 &

99-125)