With communities nationwide struggling to address the booming opioid epidemic, Maryland is the first to declare a state of emergency in an attempt to rein in overdoses within its borders. In 2016, the Maryland residents suffered more than 2,700 fatal opioid overdoses; this figure is climbing at an alarming rate. The state of emergency declaration allowed Governor Larry Hogan discretion to allocate $50 million in funding to fight the epidemic without waiting for legislative approval. This funding is in addition to Maryland’s previous and ongoing efforts through the Heroin and Opioid Emergency Task Force, the 2017 Prescriber Limits Act, and the 2017 Heroin and Opioid Prevention, Treatment, and Enforcement Initiative.
While Maryland’s attack on the opioid epidemic does not specifically address workers’ compensation claims, the policy changes regarding opioid prescriptions and addiction education will likely have an indirect effect. Maryland has established a Prescription Drug Monitoring Program (PDMP) which is mandatory for nearly every prescriber of Controlled Dangerous Substances (CDS), in addition to pharmacies. Reports must be made within three days of prescribing a CDS (Schedule II-V). This allows for one central database to identify a patient receiving multiple prescriptions at one time. Beginning on July 1, 2018, providers seeking to dispense opioids or benzodiazepines are required to review a patient’s PDMP history, and make a record of that review, before writing a prescription. While this information is not available for use in workers’ compensation proceedings, it allows the prescriber to be the first line of defense in identifying abuse.
Given the reporting requirement, PDMP is likely to discourage overprescription of opioids. The Department of Health and Mental Hygiene routinely seek administrative sanctions against medical licenses of overprescribers (this generally involves subpoenaing medical records of a sampling of patients and looking for excessive prescriptions). With the advent of PDMP, all of the information needed to pursue administrative license sanctions against an overprescriber will be contained in one database. We can hope that we will see a decline in overprescribing, including in workers’ compensation claims, simply based on the reporting requirements.
Further commonsense legislation passed in May of 2017 establishes guidelines for health care providers prescribing opioids. Providers now must prescribe the lowest effective dose, in the lowest quantity that is necessary (with a few exceptions, including chronic pain). The dosage, quantity and duration of prescribed opioids must be based on clinical guidelines established for CDS. While Maryland does not have its own standards regarding CDS prescriptions, the Center for Disease Control published comprehensive guidelines in 2016. In any workers’ compensation cases where the claimant is receiving a dosage or duration of opioids in excess of the CDC guidelines, there is now at least a measure to point to in assessing the appropriateness of a claimant’s medication regimen. Time will tell how effective these measures are in practice, but Maryland is moving in the right direction by tackling this crisis head on.