Ten years ago, Jon Hinck was a lawyer representing addicts in a class-action lawsuit against the maker of OxyContin.

It was already clear that the little pills were much more addictive than the company claimed, and that Maine had a new drug abuse epidemic, Hinck said.

“Everywhere you turned were officials saying, ‘We’re getting on top of this problem,'” Hinck said. “Ten years later, it hasn’t been getting better. It’s been getting steadily worse.”

Now, as a state legislator from Portland, Hinck is among the state officials and addiction experts who are pushing for a more aggressive effort to cut off the steady flow of prescription painkillers to people who sell and abuse them.

“It’s too damn easy,” he said.

Maine has, in fact, responded to the epidemic with a long list of policies and initiatives. Some, such as tamper-proof prescription pads and overdose prevention campaigns, have made a difference.

Maine is also considered a national leader in collecting and disposing of the unused drugs in medicine cabinets around the state. More collection events will be held around the state on Saturday, Oct. 29.

But a decade into the effort, there still is limited coordination and communication among the groups that are involved in the problem, including dentists, physicians, hospitals, pharmacies, health insurers, licensing boards, schools, police departments, drug enforcement agencies and state officials.

“This is a silo-breakdown kind of problem,” said Dr. Tamas Peredy, an emergency medical physician in Portland.

Police arrest dealers, for example, but don’t warn the doctors who are writing prescriptions for them. On the other hand, doctors who catch someone abusing prescriptions don’t typically tell the police.

The state now tracks virtually every painkiller prescription filled in Maine, but it hasn’t committed the resources to use the information aggressively.

Doctors can check a database to make sure their patients aren’t getting the same drugs from other doctors, but most never look. Police, meanwhile, need a court order to get access to the records.

“A lot of things have to do with resources and a lot of it has to do with identifying things people can do across jurisdictions,” said William Savage, an assistant state attorney general.

Coordination has improved in some areas.

State-funded Overdose Prevention Projects in Portland, Bangor and Waterville routinely bring together people from the law enforcement, treatment and medical communities to respond to new trends.

Treatment providers and police in Maine’s midcoast also meet periodically to share information.

The Maine Medical Association works with drug enforcement agents and state officials to train Maine doctors how to help legitimate pain patients while reducing abuse and addiction.

And the Maine Drug Enforcement Agency, which hasn’t been able to afford a full-time prescription drug unit since the 1990s, has been using temporary federal money to employ two full-time prescription drug agents — one in Aroostook County and one in Penobscot and Piscataquis counties. While they make undercover stings and drug raids, their primary duty is to talk with physicians and pharmacists to encourage cooperation and gather leads.

“(It) is breaking down those barriers,” said MDEA Director Roy McKinney.

The federal funding is running out, so McKinney is trying to keep the work going within his own payroll.

Chris Gardner, the prescription drug agent for Penobscot and Piscataquis counties, spent part of this summer warning pharmacists about narcotic prescriptions written in Florida. Dealers have been driving or flying south to get prescriptions from clinics known as “pill mills,” then filling the prescriptions in Bangor and other communities and selling the pills for huge profits.

“We’re under no misconception that we are going to enforce our way out of this problem,” Gardner said. “Sharing information is the key to slowing it down.”

Now, Gardner is helping to develop a Diversion Alert Program in northern Maine. It will send monthly bulletins to doctors with the names of people who have been arrested or charged with possessing or selling prescription pills. He hopes it will give prescribers another tool to weed out patients who may be faking pain and diverting the medication.

It’s not clear how to spread the idea statewide because of the sheer number of arrests in places such Penobscot and Cumberland counties. But some say it is the kind of coordination needed at the state level.

“A lot has been done. I don’t think it’s sufficiently coordinated,” said Hinck, the Portland lawmaker and former class-action lawyer.

Hinck proposed legislation early this year that would have mandated new procedures for prescribers and pharmacies. Among other things, it called for all prescribers to join Maine’s drug-monitoring database and all pharmacists to check identifications to make sure patients didn’t forge prescriptions. Both practices are now voluntarily and sporadic. The proposal was based on legislation enacted recently in Washington state and considered the most aggressive in the nation. It failed in the Maine Legislature.

The medical community, and ultimately lawmakers, said the bill went too far by mandating a range of medical practices. It would have required that some patients be referred to pain management specialists, for example, even though Maine has few such physicians.

Doctors must be free to care for their patients and adapt to new treatments and care standards, opponents said. Cumbersome mandates also might lead some doctors to stop prescribing the painkillers to patients who legitimately need them, some warned.

“I think doctors do need to recognize that they have some responsibility for the problem of diversion and addiction, but my concern about legislating the behavior is that it may have unintended adverse consequences for patients,” said Dr. Stephen Hull, co-director of the Mercy Pain Center in Portland.

Pharmacies viewed the mandated ID checks as a burden on customers.

Pharmacists can already request identification if they are suspicious, said Douglas Carr, an attorney who represents Rite-Aid of Maine. But they don’t want to make customers wait unnecessarily, he said. “If you do that for everyone, you’re going to have some very unhappy customers, and 95 percent of the customers are legitimate.”

While it rejected the mandates, the Legislature created a study group to find ways for the medical community to tighten up access to the pills. The group, which includes doctors, addiction experts and lawmakers, is due to report to the Legislature in December.

 

Copy the Story Link