Code of Maine Rules
02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION
396 - BOARD OF LICENSURE OF PODIATRIC MEDICINE
Chapter 21 - USE OF CONTROLLED SUBSTANCES FOR TREATMENT OF PAIN
Section 396-21-2 - DEFINITIONS

1. Abuse - A maladaptive pattern of drug use that results in harm or places the individual at risk of harm.Abuse of a prescription medication involves its use in a manner that deviates from approved medical, legal, and social standards, generally to achieve a euphoric state ("high") or to sustain opioid dependence, addiction, or that is other than the purpose for which the medication was prescribed.

2. Acute pain - The normal, predicted physiological response to a noxious chemical, thermal or mechanical stimulus and typically associated with invasive procedures, trauma and disease. Acute pain is generally time limited, often lasting less than 90 days.

3. Addiction - A primary, chronic, neurobiologic disease, with genetic, psychosocial and environmental factors influencing its development and manifestations. Addiction is characterized by behaviors that include the following: impaired control over drug use, craving, compulsive use and continued use despite harm. Physical dependence and tolerance are normal physiological consequences of extended opioid therapy for pain and are not the same as addiction.

4. CDC - U.S. Department of Health and Human Services Centers for Disease Control and Prevention.

5. Chronic Pain - A state in which pain persists beyond the usual course of an acute disease or healing of an injury that may or may not be associated with an acute or chronic pathologic process that causes continuous or intermittent pain for more than 90 days and may last months or years.

6. Clinician - An allopathic (MD) or osteopathic (DO) physician, physician assistant (PA), advanced practice registered nurse (APRN), or podiatrist (DPM).

7. Controlled Substance - A drug that is subject to special requirements under the federal Controlled Substances Act of 1970 (CSA), as amended; see 21 U.S.C. § 801, et seq. Most opioid analgesics are classified as Schedule II or III under the CSA, indicating that they have a significant potential for abuse, a current acceptable medical use, and that abuse of the drug may lead to severe psychological or physical dependence.

8. Drug Diversion- The transfer of a controlled substance from authorized legal and medically necessary use or possession to illegal and unauthorized use or possession.

9. Functional Assessment- An objective review of an individual's ability to perform key activities of daily living including mobility, self-care, ability to do household chores, work and engage in social interactions. It is used to establish or determine appropriate therapeutic interventions.

10. Hospice Services - Is defined in Title 22 M.R.S., section8621, subsection 11 and means a range of interdisciplinary services provided on a 24-hours-a-day, 7-days-a-week basis to a person who is terminally ill and that person's family. Hospice services must be delivered in accordance with hospice philosophy.

11. Medical Emergency - Means an acute injury or illness that poses an immediate risk to a person's life or long-term health.

12. Misuse-All uses of a prescription medication other than those that are directed by a clinician, used by a patient within the law, and within the plan of treatment.

13. Morphine Milligram Equivalent (MME) - A conversion of various opioids to a morphine equivalent dose by the use of accepted conversion tables.

14. Opioid - Any compound that binds to an opioid receptor in the central nervous system (CNS), including naturally occurring, synthetic or semi-synthetic, and endogenous opioid peptides.

15. Opioid Agonists - Drugs that bind to the opioid receptors and provide pain relief. Examples include morphine, oxycodone, hydromorphone, fentanyl, codeine, and hydrocodone. Buprenorphine is a partial agonist, meaning it activates the opioid receptors in the brain, but to a much lesser degree than a true opioid.

16. Opioid Antagonists - Drugs that cause no opioid effect and block full agonist opioids such as morphine. Examples are naltrexone and naloxone. Naloxone is sometimes used to reverse a heroin overdose.

17. Opioid Use Disorder - See Diagnostic and Statistical Manual of Mental Disorders (DSM) DSM-5 criteria. https://www.buppractice.com/node/1514.

18. Pain - An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.

19. Palliative Care-Is defined in Title 22 M.R.S., section1726, subsection 1, paragraph A, and meanspatient-centered and family-focused medical care that optimizes quality of life by anticipating, preventing and treating suffering caused by a medical illness or a physical injury or condition that substantially affects a patient's quality of life, including, but not limited to, addressing physical, emotional, social and spiritual needs; facilitating patient autonomy and choice of care; providing access to information; discussing the patient's goals for treatment and treatment options, including, when appropriate, hospice care; and managing pain and symptoms comprehensively. Palliative care does not always include a requirement for hospice care or attention to spiritual needs.

20. Serious illness- Is defined in Title 22 M.R.S., section1726, subsection 1, paragraph B, and means a medical illness or physical injury or condition that substantially affects quality of life for more than a short period of time. "Serious illness" includes, but is not limited to, Alzheimer's disease and related dementias, lung disease, cancer, heart, renal or liver failure, and chronic, unremitting or intractable pain such as neuropathic pain.

21. Physical Dependence - A state of adaptation manifested by drug class-specific signs and symptoms that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist. Physical dependence, by itself, does not equate with addiction.

22. Substance Abuse - The use of any substance(s) for non-therapeutic purposes or for purposes other than those for which it is prescribed.

23. Substance Misuse- The use of a medication (with therapeutic intent) other than as directed or as indicated, and whether harm results or not.

24. Terminally Ill - Is defined in Title 22 M.R.S., section8621, subsection 17 and means that a person has a limited life expectancy in the opinion of the person's primary physician, physician assistant, advanced practice registered nurse, or medical director.

25. Tolerance -A state of physiologic adaptation in which exposure to a drug induces changes that result in diminution of one or more of the drug's effects over time. Tolerance is common in opioid treatment, has been demonstrated following a single dose of opioids, and is not the same as addiction.

26. Universal Precautions - A standardized approach to the assessment and on going management of all pain patients who are prescribed controlled substances.