Doctoring General Medicine Health Care Reform

In the treatment of pain, OPIOID helps caregivers weather the regulatory storm

What follows is a guest post. James Patrick Murphy, MD, MMM is board-certified in Pain, Addiction, and Anesthesiology. He is President of The Greater Louisville Medical Society and the Course Director for OPIOID — Optimal Prescribing Is Our Inherent Duty.

Dr. James Patrick Murphy
Dr. James Patrick Murphy

Dr Murphy, a friend, writes on the matter of optimal prescribing of pain therapy. It’s a timely and important topic. As a bike racer, I have experienced the anguish of pain. From a patient perspective, the problem with pain is not just that it hurts, but also, that it’s hard to see the end of suffering. Thankfully, I have been lucky to have had compassionate caregivers, all of whom prescribed pain therapies that worked without causing adverse effects.

From the perspective of a caregiver, the treatment of pain is vexing. On the one hand is a fellow human in need of compassion. Caregivers are called to care. But as it is in many diseases, treatments for pain are far from perfect. Each comes with the potential for adverse effects. I’ve written extensively about the dangers of NSAIDs. Propublica has exposed the under-recognized  dangers of high-dose acetaminophen. And we all now about opioids. My state of Kentucky has been an epicenter of opioid-related issues, including unintended consequences of well-meaning regulations.

Enough of me. Here’s Dr Murphy:

OPIOID Helps Caregivers Weather the Regulatory Storm

Healthcare is engulfed in a torrent of regulations raining down upon caregivers. Nowhere is this more evident than in the delivery of pain care. Perhaps OPIOID is the way to weather this storm.

Allow me to explain…

Recently, I was talking with a sales rep from a drug screen lab, and our conversation naturally veered into a discussion about how states were beginning to require urine drug screens for patients receiving pain medication.

To a drug screen lab these regulations are like liquid gold.

But as easily as regulations are passed, they can be erased. And if the success of a lab is based on the existence of a regulation, then the business model is built on thin ice and for the wrong reasons. If the regulations dry up, so does lab.

I’m a physician, and – like the lab – I expect compensation for what I do.

What I do is care for people by applying factual knowledge, energized by creativity, in accordance with evidence-based protocols, while remaining cognizant of the mysteries still misunderstood and the mysteries awaiting discovery. It’s a marriage of science and art.

I know that following regulations goes along with the territory. But following regulations does not make me jump out of bed every morning with passion and determination. A regulation never delivered a baby, bypassed a clogged artery, or discovered a cure. People do these things. People need these things. I’d rather work for people than a regulation.

The delivery of pain care is perhaps the most regulated activity in medicine. And depending on the state, the regulations can seem foreboding to the caregiver. The message is clear. Either get on board or the Board will get on you.

The thought of abandoning our suffering patients out of fear is bitter. The thought of losing our licenses is chilling. And the thought renouncing our calling as patient advocates to blindly follow regulations we don’t even understand… is demoralizing.

It doesn’t have to be this way.

Remember my lab rep? My advice to her was to go back to her supervisors and suggest that they promote their product primarily as a means to help patients by helping prescribers. Then they would be serving the best interest of millions of people, as opposed to serving at the pleasure of a few hundred lawmakers. In other words, make improved quality of life the real goal – not adherence to regulations.

That’s what OPIOID is all about. OPIOID means Optimal Prescribing Is Our Inherent Duty – a seminar conceived by physicians, approved by Kentucky’s Medical Board, and produced by the Greater Louisville Medical Society in association with the University of Louisville – February 7 – 9, 2014. The goal of OPIOID is to empower prescribers to optimally care for suffering patients and adhere to the governing regulations. People can register by email: [email protected] or call: 502-736-6354 or visit online at: (and click on the “OPIOID” tab).

OPIOID is a prime example of caregivers holding steadfast to their calling in the regulatory storm. Please spread the word. Together we can weather this.

James Patrick Murphy, MD, MMM
January 26, 2014

Dr. James Patrick Murphy is board-certified in Pain, Addiction, and Anesthesiology. He is President of The Greater Louisville Medical Society and the Course Director for OPIOID.

Dr. Murphy blogs at Confluential Truth, and can be followed on Twitter @jamespmurphymd.

2 replies on “In the treatment of pain, OPIOID helps caregivers weather the regulatory storm”

I’m afraid I have to convey disappointment in the above statement, “Propublica has exposed the under-recognized dangers of acetaminophen”. Written by 2 investigative journalists – their emotionally charged piece distorts the reality that under most circumstances – acetaminophen is safe. No drug is perfect – there have been tragedies (as they describe) – but one leaves their post thinking acetaminophen is among the most dangerous substances known-to-man, which is not the reality. Properly used – acetaminophen is far safer as a longterm analgesic than NSAIDs, especially in an older adult with arthritis and other underlying conditions.

Thank you Ken.

I added the adjective “high-dose” before acetaminophen in the body of the post. Despite its brevity, your comment touches on many important topics. One is that no drug (no medical intervention) comes without tradeoffs. The “no free lunch” phrase works well for all of medical therapeutics. Two is that that was an emotionally-charged Propublica piece. When I read it, I thought about the small numbers of acetaminophen adversities versus the near-daily barrage of NSAID-related hospital admissions. The mainstream medical community is far too nonchalant about the dangers of NSAIDs. Almost every week, I see an older patient with cardiovascular issues who has been prescribed an NSAID. Unbelievable. Third, I concur completely that wisely used acetaminophen offers older patients w/ arthritis a safer option than NSAIDs.

The reason I wrote with that tone is that I have already seen how opioid scrutiny has resulted in an increase in the use of both NSAIDs and acetaminophen. I don’t dismiss the problems with opioid addiction, not at all, but central to the job of doctoring is compassion–a concern for others, especially those who suffer pain.

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