MaineHealth

Important things for providers to remember about Public Law Chapter 488

• Patients on high doses of prescription opioids are at higher risk for addiction to illegally obtained medications and heroin. A top priority in any conversation about reducing or eliminating opioid medications is to keep the patient from turning to street drugs in response to any change in treatment. Assume this risk is present in all patients, regardless of socio-economic status.

• Reassurance and a clear willingness to work through patient concerns should preface any communication about reducing or eliminating opioid pain medication.
• Difficult conversations should take place face-to-face. Written communications and phone contacts should be reassuring and focus on setting up a face-to-face conversation with a provider about treatment options going forward.
• Chapter 488 contains a number of exemptions from the 100 MME per day limit set to take effect at the start of the next calendar year. Outreach should focus on those patients taking more than 100 MMEs daily who DO NOT fall into an exempt category (see adjacent Fact Sheet). You may have to put staff resources into determining which patients should be contacted.
• If you are a primary care provider and your patient gets a prescription for opioids in excess of 100 MMEs daily from another source, such as a pain clinic, take the initiative to reach out the prescribing provider and coordinate a plan for bringing that patient‟s treatment in line with the law.
• Patients can sometimes become agitated when they sense their access to opioid medication is about to be eliminated or reduced. Have a patient-centered plan in place to that offers alternatives and helps to diffuse the situation. Bear in mind that how a patient is treated in this circumstance may have a direct impact on whether they turn to street drugs as an alternative.
• Always remember that difficult and emotionally-charged issues are best tackled with the support and input of a team. Consult your colleagues, particularly those from Maine Behavioral Healthcare, and leverage support across the MaineHealth system as you undertake bringing prescribing practices in line with the new law.

MaineHealth

Starting the conversation: Talking points for patient interactions

• Use compassionate language and be understanding of the patient‟s emotions. The patient may be filled with anxiety or even fear over making a change, and these emotions can easily translate to anger or their being less-than-forthcoming. Stay calm and supportive and reflect back how hard this must be for them.
• Strengthen your patient‟s knowledge of the risks and benefits of all treatment options. Express your concern over risks - accidents, injury, accidental overdose, premature death, heart disease, driving impairment, becoming the victim of a crime, dependence, addiction and other side effects – but don‟t use these as debating points to “win” an argument.
• Don‟t be fatalistic. Be positive about getting to a better place if you work together.
• Be sure that all staff who have contact with the patient understand the need to be supportive and patient-centered in these conversations.
• If it is determined that opioids are to be part of a treatment plan going forward, be clear about the requirements and limits now in place.

Sample conversation opener:
"I‟ve been thinking a lot about you and your treatment. Please know, we are here first and foremost to give you the best possible care, and I appreciate that it can be difficult to think about change.

"Still, as new information becomes available, it is more and more apparent that the medications you are taking are not the right ones for your problem, and I think we need to look at a safer and more effective treatment plan. These medications have a lot of side effects and risks - not just addiction, but things like heart disease and premature death. This worries me.

“I recognize this won‟t be easy, but I am convinced it will be worth it. I will work with you and your family every step of the way and be available to you. We will get there together. So let‟s talk about some options and a safe, comfortable plan for you to make a change in the coming weeks and months.”

Public Law Chapter 488 – Talking Points for Providers
July 1, 2016