AUGUSTA, Maine — Jane Avery says the pain from her psoriatic arthritis is the worst at 2 a.m. when she can't sleep and already has met her daily limit on painkillers. Her daily dosage of the drugs was cut in half about six months ago.
Avery, 81, says she and other chronic pain patients are suffering as Maine rolls out the nation's strictest law targeting opioid prescriptions. By July, Maine doctors will not be allowed to prescribe more than 100 milligrams of opioid medication per day to most of their patients.
State health officials say the law has exceptions that can help the estimated 16,000 Mainers who get high daily doses of opiates for chronic and acute pain. But Avery and others with chronic pain have told lawmakers their doctors say they don't qualify for an exception.
"It's like we have to go on bended knee and beg, and it shouldn't be that way," she said.
About 10 percent of the Maine patients receiving high daily doses of opioids will face increased depression and suicidal tendencies on reduced doses, cautioned Dr. Steven Hull, director of a pain rehabilitation program at Mercy Hospital in Portland.
The law comes as Maine deals with the nation's highest rate of prescriptions for long-term opiate medication. Last year, at least one person died each day in the state from drug overdoses.
And there's evidence the problem is improving, said Gordon Smith, executive vice president of the Maine Medical Association. Retail prescriptions of opioid painkillers in Maine declined 21.5 percent from 2013 to 2016, compared with 14.6 percent nationally, according to health information company QuintilesIMS.
Maine's law has exceptions for "palliative care," cancer pain patients, end-of-life care, hospice care and and medication-assisted treatment for substance use disorder. Some doctors and medical groups say the law doesn't clearly define "palliative care."
Several lawmakers at a Thursday hearing said doctors think of end-of-life care when they hear palliative care. Meanwhile, "the state believes that palliative care is anything they need an exemption for," Smith said.
Doctors are simply concerned about violating the law, said Dr. Alan Ross of Augusta. He said lawmakers need to better define when an exception is OK, something legislators are is considering.
The law also is receiving pushback from the Academy of Integrative Pain Management, an association of doctors, chiropractors, acupuncturists and others who treat pain.
Protections in Maine's law were not broad enough and left "many patients at risk of inadequate medical care," wrote Katie Duensing, the academy's assistant director for legislative and regulatory affairs, in recent testimony to lawmakers. She said health care providers should be able to prescribe higher doses "on a case-by-case basis."
Brandy Stokes, a single mom from Bangor with three teenage sons, is awaiting reconstructive surgery and hoping she won't lose her left leg and foot. She told lawmakers she's received opioid painkillers for six years, which requires yearly contracts, urine screenings, random pill counts and counseling.
"People who suffer from daily pain are a separate issue from those who are addicted," she said.