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Maryland doctors win concessions on Hogan proposal to limit pain pill prescriptions

Maryland's doctors are on course to resist a plan to put strict limits on the prescription of addictive opioid pain pills, securing major concessions Tuesday from a key House of Delegates panel on one of Gov. Larry Hogan's top proposals for battling the state's heroin crisis.

Maryland's doctors are on course to turn back Gov. Larry Hogan's plan to put strict limits on prescribing addictive opioid pain pills after securing major concessions Tuesday from a key House of Delegates panel.

The bill — proposed by Hogan to battle the state's heroin crisis — would have limited doctors and other medics to prescribing a seven-day supply of the pills when first treating a patient for pain, with a few exceptions. But a work group of delegates adopted an amended version of the bill that instead instructs medical professionals to follow best practices and give patients as few pills as they judge necessary.

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The legislation wouldn't apply to patients getting treatment for an opioid addiction, who are in hospice care or who are suffering chronic pain.

The legislative panel also rejected an idea that would have allowed department officials to strip doctors of registrations needed to prescribe controlled drugs if they violated provisions of the bill. The Department of Health and Mental Hygiene said that provision would be critical to the success of the law, but it was strongly opposed by the state's medical society.

Gene Ransom, the executive director of MedChi, the medical society, said Hogan's ideas sounded good but would have created problems for doctors.

"This makes much more sense from a clinical point of view," Ransom said of the rewritten bill. "A seven-day limit in some circumstances isn't practical."

The Republican governor announced the bill in February as part of a package of legislation designed to tackle the high rate of fatal overdoses caused by heroin and other opiates.

While the powerful pain medicines have many legitimate uses, they can send some patients spiraling into addiction. Other states have been able to put restrictions similar to those initially proposed by Hogan into law over the objections of doctors.

Amelia Chasse, a spokeswoman for Hogan, said the administration was pleased the bill was moving forward and that the governor's office would work with legislators "to ensure the bill is as strong as possible and will help save lives."

An estimated 2,000 people died from heroin and opiate overdoses in 2016, prompting Hogan to declare a state of emergency and promise more funding to tackle the problem. Legislators are also working on a several bills designed to make it easier for addicts to get treatment and that would create new educational programs about the dangers of drug use.

Ransom said many of the changes to the prescribing bill were worked out between the health department and the medical society. But they were unable to agree on who should be allowed to strip doctors of their licenses and asked the legislative panel to adjudicate. The delegates voted to strip that provision from the bill.

Christi Megna, a health department lobbyist, said giving officials such power would be a deterrent to clinicians who might otherwise be tempted to break the law. The power would be justified because of the scale of the heroin crisis in Maryland.

"This is critical," she said. "This is what the department believes is the engine that's going to drive the success of this piece of legislation."

But Pam Kasemeyer, a lobbyist for the medical society, told the delegates Wednesday that the state office charged with making decisions about the licenses would not be equipped to make sound decisions.

"We think it creates a very unfair process," she said.

The bill still needs approval from a House of Delegates committee before moving forward to the House floor, but the recommendations of legislative work groups are typically upheld.

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Del. Nic Kipke, the Republican leader in the House and member of the work group, voted in favor of giving the department new powers over dangerous substance licenses.

"The crisis demands stronger oversight," he said in an interview. Even without that provision, Kipke said the bill would help change medical culture by sending a signal to doctors that they need to be careful about doling out opiate pain medication.

Del. Eric Bromwell, a Baltimore County Democrat who is running the work group, said the bill would be an improvement on current state law.

"I absolutely support what came out of the work group," he said.

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