ANNAPOLIS — Gov. Larry Hogan wants to curb heroin and opioid abuse, long before addiction. One of three bills the Republican governor plans to introduce this General Assembly session is the Prescriber Limits Act, which would limit opioid prescriptions upon an initial consultation or treatment to a seven-day supply.

In a press conference Tuesday at Anne Arundel Medical Center, Hogan and Lt. Gov. Boyd Rutherford outlined their administration’s past and current efforts to address the ongoing heroin epidemic, which claimed an estimated 51 lives in Frederick County last year.

The Prescriber Limits Act comes as other states are considering similar legislation.

A U.S. Centers for Disease Control and Prevention guideline issued last year concluded that three days’ worth or less would be sufficient for most acute pain, and more than seven days’ worth of opioid pain medication would rarely be needed. Limiting initial prescriptions is critical because long-term opioid use often begins with treatment of acute pain, according to the CDC.

Connecticut, Maine, Massachusetts, New York and Rhode Island passed legislation that limits initial opioid prescriptions to seven days’ worth in 2016, according to a National Conference of State Legislatures database. Pennsylvania enacted a law that requires a limited seven-day supply in certain situations, including when prescriptions are written in emergency departments or for minors. In Arizona, an executive order from the governor implemented a seven-day prescription limit in certain situations. At least two other states — Indiana and New Jersey — have pending prescriber limit legislation, according to NCSL.

Exceptions to the limit proposed by Hogan would apply when the opioid is prescribed for the treatment of pain associated with a cancer diagnosis or a terminal illness, or to treat a substance-related disorder. The full text of his proposed bills was not available Tuesday. The bills are scheduled to be formally introduced in the General Assembly on Wednesday.

The bill will likely be reviewed by the House Health and Government Operations Committee. Delegate Karen Lewis Young, D-District 3A, is a member of the committee and tried to pass legislation last year that would have held so-called “pill mill” doctors liable and subject to civil fines if improper prescribing led to an overdose death. The bill faced backlash from some medical organizations and was voted down by the House Judiciary Committee.

Without having seen the full text of the bill, Lewis Young said that there is some appetite in Annapolis for rolling back opioid prescriptions, but maintaining proper access to medical care for people in pain is also very important.

“It’s the greatest challenge ... finding that balance,” Lewis Young said.

She will not reintroduce her legislation this year, and is instead focusing on improving access to treatment programs, including at the Maryland Sheriffs’ Youth Ranch in Frederick County.

The two remaining bills from Hogan focus on overdose prevention and a new form of criminal prosecution.

The Overdose Prevention Act would expand the analyses by county fatality review teams to include non-fatal overdose data in addition to the fatal overdose data they currently review. The goal is to allow the review teams to recommend overdose prevention strategies.

The bill would also expand access to naloxone prescriptions directly from a pharmacist without the current training requirements and extend immunity provisions to pharmacists. Additionally, the bill would allow the Department of Health and Mental Hygiene’s Office of Controlled Dangerous Substances Administration to more easily take action against the controlled dangerous substance registration of a prescriber or dispenser based on investigations of the federal Drug Enforcement Administration or a state professional licensing board.

The Distribution of Opioids Resulting in Death Act would create a new felony charge that would allow police and prosecutors to seek up to 30 years’ imprisonment against sellers of opioids or synthetic opioids when the drugs lead to death. The bill would target kingpins and contains protections for those who sell drugs to support their own addiction, according to the governor’s office.

Hogan also signed an executive order on Tuesday. That measure authorizes the state’s Inter-Agency Heroin and Opioid Coordinating Council to establish a statewide Opioid Operational Command Center. The center will bring together the work of federal, state and local organizations, with a focus on data collection to inform future policy decisions.

Follow Danielle E. Gaines on Twitter: @danielleegaines.

Danielle E. Gaines covers politics and government in Frederick County, splitting her time between Winchester Hall and The State House. Having grown up in Illinois, she lived in New York and California before settling in Maryland.

(8) comments


MRS M: I'm going to keep this short, but you are sadly misinformed. The idea that those supposedly addicted to narcotics are then on the hunt for heroin is ridiculous. Does everybody know somebody who sells heroin? Also; be aware that the vast majority of people who take opioids for post-surgical pain stop taking them when healing takes over. They simply don't take them any longer if they have any left over. And, such people don't have family members looking into their medicine cabinets. Such are the cases where teens get into their parents' meds.

I have seen cases of REAL pain. My late brother-in-law had a spinal cord injury and was in a wheelchair in the last years of his life.

Also; be aware that most people do not get euphoric feelings with opioids. Typically, people just get nausea to the point of vomiting. Not to mention, they affect respiration to the point of not being able to tolerant them.

The regulation already in place (including in Maryland) is that the patient themselves have to pick up their prescriptions for controlled substances. It already is a problem, especially for those in wheelchairs. This includes our veterans. Be aware that many, many people don't have friends or family who can handle getting them into a vehicle, carrying the weight of the patient in transport, etc.


Since Sue1955 states with great authority that the " vast majority of people who take opioids for post-surgical pain "stop taking them when healing takes over. They simply don't take them any longer"............well, supplied with her "facts", those short -term, post-op patients wouldn't be affected by the proposed legislation, would they? No worries there. Nor would her late brother-in-law, chronically ill and (presumably) closely monitored by his physician. To further understand the devastation wracked on patients, families, and society by opioid addiction (including the transition to heroin), and the need to create INITIAL prescribing limits in a valid attempt to PREVENT addiction to these brain-altering drugs, Sue1955 may want to just slightly broaden her already considerable understanding of the depths of this problem, by reading the January 28th opinion of Dr. Julio Menocal, who, in his column in the FNP following Mr Hogan's action, advocated for an initial prescription of THREE days, not SEVEN as the proposed law advocates. This doctor's very enlightening column, informed by both EXPERIENCE and FACTS, clearly underscores the problem.......unlike sue1955...whose absolute proof that there really isn't a need for a initial limit law or a problem here because "people taking opioids for post-surgical pain don't have family members looking into their medicine cabinets", followed by "they affect respiration to the point of not being able to tolerant them". Not able to tolerate them? Yes, death by respiratory supression , or as sue states: "affected respiration" is the best way to stop taking them. Maryland's Department of Health and Mental Hygiene reports 920 overdose deaths just in the first half of 2016. They also state in their September 22, 2016 Update that: "opioid addiction often has its roots in prescribed medication". PREVENTION is the key, Sue, and holds the only real hope of stemming the tide. You might think about whether the loved ones of any of those 920 people lost just in the first half of 2016 would now support a law limiting their loved one's intial prescription to 7, or even better, 3 days.


I was surprised by 2 things in the comments noted here today. The first is that so few people were inspired to comment on Mr.Hogan's proposals, given the opioid epidemic that is effecting our country, with its accompanying loss and heartbreak for affected families. Secondly, I was surprised that the 4 (!) comments were generally negative. I applaud Governor Hogan, and thank him for making an attempt to stem the flow of drugs, addiction, overdoses and deaths. As with most public health crisis', PREVENTION is a beginning. And the passage of a law that would limit initial prescriptions to 7 days would be an exemplary send yet ANOTHER message to patients and the prescribing community of the care, counseling, and education that should be given when prescribing these dangerously addictive medications. And since we are aware that denial is one of the foremost features of those who are drug-dependent, we might also recognize that the responsibility again falls on the subscriber to carefully the best of their ability..... whether the patient reporting severe pain is truly suffering the level of pain that requires 120 pills per month (or more), vs having developed a life-threatening dependency. No pill mills in Maryland? I'm not sure about that, but there have been plenty of prescribers writing high volume scripts for people reporting severe pain. Sadly, when those patients are ultimately "cut off" or priced out of their addiction, heroin addiction does follow. So, perhaps Governor Hogan's attempt to PREVENT patients from getting started on the heartbreaking road to addiction, by limiting initial pills dispensed in select cases,is the best idea of all. It's a good and thoughtful start. Thank you, Mr. Hogan.


Not to mention, Maryland does not have "pill mills." For people who might not know what they, they are businesses that are set up with a doctor who - for a fee- basically provides whatever pills you want. Ohio was one state that had them originally. To the best of my knowledge, the authorities in that state closed them down.

In yesterday's Washington Post; there were several well-stated comments against this proposal, including mine.


What a misguided and short-sighted proposal of the Governor's.


Agreed. This only hurts the ones that abide the law. The pill mills will still be out there.


Thank, Governor Hogan, but now it will be necessary for more medical marijuana.


The chem companies marketed these drugs as ideal for treating anything, and adverse effects not admitted. Doctors believed their info. When, finally, the real effects went public, it was "blame the patient." These companies made billions, no responsibily for any damage to public health. And so it goes....

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