Like nearly every state, Maine is dealing with an opiate and heroin epidemic. In 2015, Maine experienced 272 overdose related fatalities.
In an effort to combat the opiate epidemic, the Maine Legislature enacted P.L. 2015, ch. 488 (An Act to Prevent Opiate Abuse by Strengthening the Controlled Substances Prescription Monitoring Program) which became effective January 1, 2017. PL 488 affects nearly all facets of healthcare by establishing specific rules for prescribing and dispensing controlled medications. It defines the protocols that must be followed and sets prescription limits on how much opiate a patient may legally be prescribed to take per day. This is called the Aggregate Morphine Milligram Equivalent and the total daily amount allowed is 100 Morphine Milligram Equivalents (100 MMEs).
PL 488 mandates that whenever a medical provider prescribes a controlled substance, they first check the PMP (Prescription Monitoring Program) to review the MME for the patient, what controlled drugs the patient is currently taking, who prescribed them and the pharmacy that filled the prescription. They must calculate if the drug they want to prescribe will, when added to the patient’s current daily MMEs, increase the allowed 100 MMEs and if so, not prescribe it. They must note if there are multiple prescriptions, providers or pharmacies. If the provider notices anything in the patients PMP profile that raises a red flag, they are required by law to report it to the PMP Coordinator. There are of course many other components to PL 488 but I only want to touch on the highlights and how it impacts Maine residents who are pet owners in addition to veterinarians. Yes, that’s correct ~ veterinarians because Maine’s Legislatures have determined that the inclusion of veterinarians in PL 488 will help reduce the opiate epidemic. I disagree because including veterinarians in PL 488 creates two major violations. First, however, I’d like to walk you through a veterinarian’s education.
If a young person thinks they want to become a veterinarian, they should begin preparing in high school by paying attention to their performance in science courses, such as chemistry, biology, and physics. This same attention applies to math courses; trigonometry, geometry, and algebra. After high school graduation the student attends a 4 year college to earn their bachelor’s degree where they take the prerequisite courses for admittance into veterinary college.These consist of many advanced science courses, such as biochemistry, organic and inorganic chemistry, and physics. They are necessary to prepare the student for the vigorous coursework in veterinary college. Prospective veterinarians must complete a doctor of veterinary medicine degree. Typically, a doctorate in veterinary medicine takes four years to complete. Of these four years, three are spent on classroom training where students take courses in animal anatomy and physiology. They also take courses on disease diagnosis, prevention and treatment. After completing three years of classroom training, students take another year left to complete their degree in veterinary medicine. The fourth year is typically spent getting practical, hands-on training. This takes the form of a one-year clinical rotation in a veterinary medical center or veterinary hospital to gain experience in a variety of areas of veterinary medicine. After graduating with a doctorate in veterinary medicine, veterinarians are not yet able to open a practice. Before practicing veterinary medicine, graduates must pass the North American Veterinary Licensing Examination and any applicable state exams. Their path is definitely not a short one but throughout it is focused primarily on one thing ~ animal anatomy, physiology and wellness.
Maines’s new PL 488 and its impact on veterinarians is such. If an owner takes their pet to be seen and the veterinarian feels it necessary to prescribe a narcotic or benzodiazepine for your pet, they must first do a check on the owner with DHHS to determine if the owner is taking a controlled substance. As I previously mentioned I still need to clarify the parameters but the fact that a veterinarian or perhaps his staff has the power to access a person’s prescriptions is a huge HIPAA violation. But I digress. Let’s use a hypothetical situation. The owner has an anxiety disorder for which he takes Valium on a daily basis. He also has a severe back issue (long-term) so is on hydrocodone for pain control. His cat is hit by a car and taken to the vet where she undergoes successful emergency surgery but because her injuries are severe, the vet prescribes a pain medication; hydrocodone. Would the fact that the owner is on hydrocodone prohibit the vet from prescribing it for the cat’s postoperative pain? If so, would he be allowed to prescribe a different pain medication such as tramadol which also falls in the opiate category? Is he is prohibited from prescribing any narcotic because the owner is on two (2)? Or is it only if the owner is on the same drug? If his prescriptive powers are limited because the owner is taking a controlled substance, what criteria is used to determine if the animal can or cannot get a prescription?
Whilst I understand the opiate epidemic our country is tackling, how can a veterinarian or anyone for that matter be absolutely certain that a person who is taking several controlled drugs is abusing or trafficking? Plus the thought that an innocent animal might have to suffer needlessly because his owner is on a controlled substance is not only abhorrent but inhumane. I want to know if it’s possible for the check to be done during non-business hours when DHHS is closed. Does the veterinarian’s office have to speak directly to a DHHS employee or is the information accessible online? And if it is accessible online, how can we, the human patient, be assured it’s secure? If the drug check on the owner can’t be done when DHHS is closed, then what happens to the animal who is in pain? Any pet owner knows that many accidents happen at night, weekends or holidays when government agencies like DHHS are closed; what then? Going back to HIPAA, who has authority within the veterinary practice to request the DHHS information? Can a receptionist do it? A vet tech? Or only the veterinarian? Finally, I do not understand how PL 488, a state law, can override HIPAA, a federal law enacted in 1996 by Congress and signed into effect by then President Bill Clinton. Under HIPAA an individual’s medical and other health information including prescriptions is private and protected. The Privacy Law sets limits on who can look at and receive our health information such as covered entities and their business associates. As a nurse and former Union representative, I am extremely familiar with HIPAA. In light of PL 488, however, I reviewed it once again and nowhere did I find where veterinarians, veterinary technicians, or veterinary employees of any type are entitled to our records in any form. Additionally, PL 488 is, in essence, requiring veterinarians to understand human medication dosages compared to animals which often differ greatly.
I chose a veterinary team for my German Shepherd based on their reputations and expertise in animal physiology, not human. I value all members of her team despite being in different practices because of their knowledge. Having said that, I expect they keep current with the newest modalities of treatment for my dog. They work long hours yet now the State of Maine expects them to undertake additional training in order to understand and monitor the Prescription Monitoring Program (PMP)? A program historically used only for humans?
This is ludicrous. There has to be a middle ground, a way the government, human healthcare providers, and law enforcement can work together in an effort to reduce the rampant drug abuse without violating a person’s rights or including veterinarians where there is potential for an animal to suffer because “something” raises a red flag when in reality it could be legitimate.