October 7, 2013
Dear Members of the Board,
Opportunity. Duty. Trust.
By allowing its Medical Licensing Board latitude to create regulations absent the boundaries of restrictive legislation, the Indiana General Assembly has afforded you a tremendous opportunity – to create regulations that balance access to effective pain care with the imperative to prevent substance abuse.
A physician’s duty is to care for the sick and the suffering, holding fast to the maxim primum non nocere, or “first do no harm.” A physician’s method begins with data collection that leads to an assessment and then to the formation of a plan. Re-evaluation follows, spawning reassessment and modification of plans when indicated. Clinical judgment is enhanced by utilizing a measured approach to prescribing, which includes starting low and going slowly, preventing over-treatment, and staunchly avoiding actions with the potential for irreversible detrimental consequences. Indeed, the most current draft of Indiana’s Emergency Pain Regulations mandates a measured approach when providing pain care, i.e. Where medically appropriate, the physician shall utilize non-opioid options instead of prescribing opioids.
A measured approach to governing our profession is prudent. Regulatory overreach has a chilling effect by making prescribers fearful of jeopardizing their licenses. This fear can result in physicians abandoning pain sufferers, even forcing some patients to seek black market medications or illicit drugs. Such has been the unfortunate case in states that hastily passed burdensome pain regulations. Heroin use in these states has increased dramatically as the supply of prescription pain medications has dwindled.
Ultimately a physician’s obligation, like yours, is to prove worthy of trust. For the Board this means drafting clear and concise regulations that do not overreach nor attempt to address every possible scenario, followed by re-evaluation and modification as necessary. The “Progress Report Card 2012” from the Pain & Policy Studies Group of the University of Wisconsin School of Medicine and Public Health supports this process and recommends that implementation of any state’s pain policy provide for periodic re-evaluation so that, if necessary, “corrective proposals” can be developed.
The Board’s task is neither simple nor easy and never should be considered a “mission accomplished.” Also, in the future more attention must be given to prevention and treatment of addiction – the root cause of prescription drug abuse – or else our best efforts will be no more effective than a dog chasing its own tail.
I have and will continue to offer my support, passion, and dedication to helping the Board in any way I can. Please contact me whenever I might be needed and expect my support.
Embrace the opportunity. Fulfill this duty. Deserve the public’s trust.
James Patrick Murphy, MD, MMM