PORTLAND — Kelly Benson practices and preaches calm and inner strength, but Maine Attorney General Janet Mills has sounded the alarm.
Both are seeking the same thing: the end of substance abuse disorders caused initially by legally obtained prescription opiates, often prescribed for pain management.
“The increase in overdose deaths has made prescribing protocols a law enforcement and public safety issue,” Mills said in a Jan. 14 statement that followed a Dec. 16, 2015, letter to the heads of several associations overseeing elements of the state medical establishment.
In her statement and letter, Mills described pathways Benson, who teaches yoga in Portland, has walked.
“I stayed connected to my yoga practice as well as positive, uplifting humans and continued to heal from all of the trauma I experienced,” Benson, a Windham resident, said Jan. 15.
Before her introduction to yoga while in treatment in 2010, Benson was using heroin because the oxycontin and percocet she had been prescribed after heart surgery were no longer being prescribed and too expensive to buy illegally.
“I swore I would never touch heroin for a very long time,” Benson said “But lo and behold, if I didn’t have oxys I became very physically sick and just couldn’t afford the habit anymore. So it wasn’t long before I tried heroin for the first time.”
Citing U.S. Department of Justice data, Mills said four of five people arrested for heroin offenses said their opioid use began with prescription painkillers. She has asked the medical community to consider taking steps, including referrals to the Prescription Drug Monitoring Program database before prescribing opiates, warning patients about the misuse of painkillers, and the option of prescribing buprenorphine, which can wean users from opioids.
“Unfortunately, many prescribers, particularly primary-care and family physicians, lack clear and practical guidance in deciding when and how to prescribe opioids,” Mills said.
She added there will be more recommendations coming from the Maine Anti-Heroin/Opiate Initiative she is leading with U.S. Attorney Thomas Delahanty and state Public Safety Commissioner John Morris.
Mills noted 174 overdose deaths occurred in Maine from January through September 2015, a pace that would top the 208 overdose deaths recorded in 2014. Of the 2015 overdose deaths, Mills said 113 involved at least one pharmaceutical drug and 111 involved illicit drugs. Pharmaceutical opioids were involved in 70 of the overdose deaths.
Gordon Smith of the Maine Medical Association said Jan. 14 that steps are already being taken to reduce the number of prescriptions, through work done by combined task forces and educational programs for physicians.
Typical of the efforts is a three-hour meeting scheduled Wednesday for the medical community at the Double Tree Hotel on Maine Mall Road in South Portland. It will be more comprehensive, Smith said, including comments from Dr. Karen Simone, who directs the Northern New England Poison Control Center.
Smith also praised efforts by the DHHS MaineCare program to reduce the number of opioid prescriptions, while substituting additional funds for treatments, including physical therapy for pain management.
The consensus is growing that opioids are not proper to prescribe for some pain management conditions, according to Dr. David Moltz, a physician in the addiction resource center at Mid Coast Hospital in Brunswick.
“We have been trained that pain is under treated and that addiction can’t happen,” Moltz said Jan. 15. “There is recognition that opiates are not appropriate for some kind of pain, such as back pain. We need to keep reminding ourselves of the risks.”
Moltz said tighter controls on prescribing opioids has led to the shift to heroin use.
“I think simultaneously, heroin is more available and cheaper as prescription drugs become less available,” he said.
There is a place for opioids in pain management, he added.
“For acute, post-surgical or post-accident pain, opiates can be really good with small doses and frequent follow up. I am comfortable with that,” he said.
Dr. Mark Fourre, who is chief medical officer at Lincoln Health in Boothbay and chief health affairs officer at Maine Health, acknowledged that shifting care options is not always well received. The shift in pain management will also require hard conversations with patients.
“I think there is increasingly accepted and broad understanding that the increased use of narcotics for the management of pain has had unexpected and significantly negative consequences,” Fourre said.
“I think one of the parts is, there is sometimes not a recognition of how difficult these situations can be,” he said. “I have seen frightening interactions and aggressive patients.”
Smith, Moltz and Fourre agreed patients getting opioid prescriptions should take urine tests to determine what other drugs they may be using.
Benson, who said she eventually lost count of how many times she entered treatment programs, is forging ahead on her own.
“I completed an intense, nine-week training in the fall of 2012,” she said. “I have not used an opiate or any pharmaceutical medications since the spring of 2013.”
Smith said it will take time for any changes to have a wider effect.
“While we are doing a lot, the numbers are not improving,” he said. “But people have to be somewhat patient, it took 10 or 15 years to get to where we are, it will take us awhile to get back to where we should be.”
Kelly Benson leads a Portland yoga class for students recovering from substance abuse disorders. She began using heroin after being prescribed narcotics following surgery.