Michigan’s New Opioid Laws: How They Affect Patients and Doctors

Our country is in the midst of an opioid crisis. Millions of people are addicted to, or abusing, opioids. And tens of thousands of people die each year from overdose.
 
It doesn’t take long for opioids to become a problem. It can start as easily as taking a prescription painkiller for an injury just long enough to become dependent on it, and it can happen in as few as two to three weeks. Dependence can quickly progress to addiction and often leads to taking less expensive street drugs like heroin.

To combat the epidemic, Michigan lawmakers have passed a set of laws aimed at reducing opioid abuse. These laws tightly regulate prescriptions that have a higher chance of being abused. They also require doctors to check a patient’s prescription history with Michigan’s prescription tracking system. Doctors must also educate patients about opioid risks when they prescribe them. And the new laws limit the amount of opioid medication that can be prescribed for severe short-term pain.

There are obviously a lot of questions about these new laws, especially from patients who rely on medications for long-term chronic pain. Patients with chronic pain won’t be affected as much by these changes.

To help you understand how the new laws will impact you or your family, here are some answers to common questions. For answers to basic questions about opioids and substance abuse, see Opioids: What They Are, Why They’re a Problem and How to Fight the Epidemic.

What’s the primary change to Michigan’s laws about opioid prescriptions?
If you have a procedure or accident, your doctor can now only prescribe a seven-day supply of pain medication. Previously, many doctors would prescribe several weeks supply. And they must first check your past prescription use on the Michigan Automated Prescription System. Your doctor can only prescribe a three-day supply if they don’t check the MAPS system.

What is the MAPS report system?
MAPS stands for Michigan Automated Prescription System. The MAPS online program provides prescribers and pharmacists detailed records on controlled substance prescriptions filled by patients. A MAPS report includes who prescribed the medication, when it was written, when it was filled, where it was filled, the number of pills or capsules, number of refills and method of payment. MAPS can provide information on prescribers, too. Your doctor can get reports on prescriptions they’ve written and who they were for.

I take care of a family member who has chronic pain due to cancer. They’re afraid they’ll be cut off from their medication and made to suffer. What’s going to happen to them?
The changes should have minimal impact on your family member. They’ll need to sign an agreement saying they won’t share their medications with others. They’ll also need to read the Start Talking form to get information about opioids and sign it each time they get a prescription.

How will this change what happens when I need to refill my pain medication?
You may wait longer because of the added steps your doctor and their staff must take to comply with the new regulations. They’re now required to:

• Check MAPS for your prescription history
  
• Tell you about substance abuse disorder, dangerous drug interactions with controlled substances, proper disposal of controlled substances, pregnancy-related issues and the rules about sharing medications 
• Have you review and sign the Start Talking consent form
  
• Possibly have you take a urine drug test
  
• Document this process and file their documents

What is the Start Talking consent form?
This form outlines the potential risks of opioids, how to safely dispose of unused medication and that sharing or selling them is a felony. Each time a doctor prescribes opioids, including refills, they’re required to review it, have it signed by the patient or a minor patient’s parent and keep it in the patient’s file.

I have real pain and have been on my medication for a long time. Can’t my doctor continue to treat my pain like they always did?
You can still get your prescriptions for chronic pain. The difference is your doctor must now provide you with information about opioids. And they have to complete the Start Talking consent form with you. You may have slightly longer wait times because your doctor must check the MAPS program before writing you a prescription.

Will it cost more for me to go to the doctor?
As a HAP member, your copay or deductible won’t change. Your doctor can’t charge you more or charge special premium payments or added fees. You may need to visit the doctor more frequently for refills as in response to the new law. More visits may mean more copays if you have an office visit copay.

Can I still see my doctor every six months for refills?
Probably not. Because of the new law, many physicians will prescribe smaller amounts of medication. This may result in more frequent visits. The law was designed to inform doctors and make sure they have data about patients and about their own prescribing habits. It has made doctors very aware of the potential risks of patients abusing medication. These can result in legal penalties for the doctor if they’re not adhering to the law. Although the law doesn’t regulate the amount of pain medication allowed for chronic pain patients, doctors may be much more careful about prescribing it.

Could my doctor refuse to continue prescribing my pain medication?
We can’t say how individual providers may choose to handle pain management under the new law. There are many options besides opioid medications to manage pain. Because of growing awareness of the risks associated with opioids, some doctors may stop prescribing them or prescribe them much less often. Your doctor may offer you a referral to a pain management specialist instead of a prescription.

If I’ve received prescriptions from more than one place, can my doctor still prescribe my pain medication for me?
Doctors must monitor prescription use through MAPS. And they must have you sign a pain management agreement. If your doctor learns that you’ve been getting prescriptions from more than one provider, you may be in violation of that agreement. It’s up to your provider to review MAPS information and discuss why you got pain medication elsewhere. A doctor may choose not to continue prescribing pain medication to a patient who’s violated a pain management agreement.

Help with opioid problems
If you or someone you care about are struggling with opioid use or abuse, it’s important to have the facts. And you’ll want to know what resources are available to help. HAP is here to assist you with information, alternative medications and counseling. We recommend you talk to your doctor first if you feel you have a problem with your medication.

If I run out of my pain medication, will I start to go into withdrawal?
If you’re taking an opioid medication such as Lortab, Vicodin or Oxycodone, you may have withdrawal symptoms if you stop taking them suddenly. The likelihood and severity of these symptoms depend on several factors. These include how high your dose is, how long you have been on the medication, what other medicines you take and your general health.

How do I know if I’m withdrawing from opioids?
Withdrawal symptoms vary a great deal. But the most common symptoms are:

• Anxiety
  
• Abdominal pain or cramps
  
• \Dizziness
  
• Flu-like symptoms
• Insomnia
  
• Muscle aches
  
• Nausea or vomiting
  
• Restlessness or jitteriness
  
• Shaking or tremors
  
• Yawning

Can I die from opioid withdrawal?

Generally, no. Unmedicated opioid withdrawal can be quite uncomfortable but is typically not life-threatening.

What can I do for withdrawal symptoms?
If you’re feeling symptoms of withdrawal, or if you’re planning to stop using your opioid or opiate medication, talk to your doctor. There are medications that can help reduce withdrawal symptoms.

I know someone who takes the same thing I do. Can we just lend each other a few pills to get us through until we can get our own?
No. Sharing opiates is not only a bad idea, it’s illegal. It’s against federal law to deliver, distribute or share a controlled substance without a prescription from a licensed health care provider. If someone is caught with a controlled substance not in a container with a label that identifies them as the person for whom it was prescribed, they’re subject to arrest and prosecution. 

If I want to wean off my pain medications, how do I do it?
Your decision to wean off your opiate or opioid medication may be an excellent step toward improving your health. There are many options for you once you’ve made this decision. Talk to your doctor about developing a weaning plan. You don’t need to be admitted to a hospital or go to a detoxification center. Medication-assisted therapy can ease temporary withdrawal symptoms. Your doctor or a pain management specialist might be able to help you manage pain without opioids.


HAP has behavioral health specialists and others to guide you through stopping opiate use. You can reach our Coordinated Behavioral Health Management team Monday through Friday from 8 a.m. to 5 p.m. at (800) 444-5755. If you call outside our regular hours, leave a message and one of our specialists will call you.

How can I manage my chronic pain without opiates or opioids?
Pain has many causes and many possible treatments. There are doctors who specialize in pain management. If you have not already talked to a pain management specialist, you might want to. You can also talk to your current doctor about pain relief methods such as:

• Acupuncture
• Biofeedback
• Exercise therapy
• Local anesthetics (patches and creams)
• Massage therapy
• Non-opiate medications
• Reiki therapy
• Yoga