Did you hear that sound?

downedtree10

On October 14, 2013 a regulatory tree fell in the woods.

Did you hear it?

The “tree” was Indiana’s emergency rule regarding opioids for chronic pain.

The tree will sound again on December 15, 2013 when it actually goes into effect.

In the meantime, I urge all physicians who practice in the Hoosier State to take a look at the document available at:

http://www.in.gov/pla/files/Emergency_Rules_Adopted_10.24.2013.pdf

Indiana Attorney General Greg Zoeller is taking an active role. Here’s his very informative website:

http://www.in.gov/bitterpill

Indiana’s “First Do No Harm” prescriber took kit (more like a textbook) is very good, up to date, and available for download at:

http://www.in.gov/bitterpill/docs/First_Do_No_Harm_V_1_0.pdf

And a fine summary poster is available at:

http://www.in.gov/bitterpill/docs/First_Do_No_Harm_Poster.pdf

The Indiana State Medical Association has had a role in this process as well.

http://www.ismanet.org/news/ViewArticle.aspx?ArticleId=836#.UnhRjJTk-XQ

And the Greater Louisville Medical Society plans on offering educational seminars in Southern Indiana.

I am currently in the process of digesting these new regulations and will soon publish an opinion on what they mean for physicians and patients.  My first recommendation is to look at that summary poster.

Trees are falling.

 

James Patrick Murphy, MD, MMM attended medical school at the University of Louisville, interned in Psychiatry at the San Diego Naval Hospital, studied at the Naval Aerospace Medical Institute, and later served as a Naval Flight Surgeon onboard the aircraft carrier U.S.S. Enterprise.  He returned to Louisville in 1989 for residency training in Anesthesiology after which he completed a Pain Medicine Fellowship at the Mayo Clinic in Rochester, MN. Dr. Murphy is Kentucky’s first physician to achieve combined board-certification in Pain Management and certification in Addiction Medicine. Dr. Murphy is President of the Greater Louisville Medical Society, Medical Director of Murphy Pain Center, Assistant Clinical Professor at the University of Louisville School of Medicine, and serves on the board of the International Association for Pain and Chemical Dependency. In May 2013 Dr. Murphy earned a Master of Medical Management degree from the University of Southern California Marshall School of Business.

Confluential Truth

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This communication is about communication.

Deep in the unconscious brain, chemical reactions coalesce. Impulses emerge. Enriched by neurotransmitters, modified by emotions, filtered through imagery, clothed in language and prepped for action by the cerebral cortex, a subset of impulses reaches critical mass and becomes a pure true thought.

Then, a tiny measure of thoughts is communicated. And, as Hamlet would say, “Aye, there’s the rub, ” because it is impossible to convey a message and be certain the recipient fully understands its true meaning.

Speak, write, sing, glare, smile, text, email, blog, touch, clap, scream, kiss –or communicate in any of another million ways – and the message hovers in space out of your control, waiting to be received by another person. Then it is absorbed, digested, filtered, modified and used as an elemental building block for the recipient’s unique perception of its meaning.

Imagine your message as a sphere with the purest and most intense truth radiating from its center. The recipient interprets your message and develops his or her own truth-sphere. Like the overlap in a Venn diagram, the effectiveness of communication is defined by the degree to which these unique spheres share the same truth. This overlap is the confluential truth.

Through effective communication, confluential truth proliferates and human connectedness occurs – like water molecules becoming rain. As more spheres overlap they form rivers of confluential truth. And when even more people get on board, the rivers fill oceans of immense power.

But with so many potential modes of communication where does one begin?

Simon says, “Start with ‘why.’”

In his 2009 book Start With Why – and later offered in a TED Talk (http://www.ted.com/talks/simon_sinek_how_great_leaders_inspire_action.html) – Simon Sinek conceptualizes effective communication as a “golden circle” with three concentric rings. The outer ring is “what,” the middle ring is “how” and the center ring is “why” (i.e. the purpose, the cause, the core belief).  Sinek contends that everyone knows what they do; that some know how they do it; but very few people know why they do what they do. Sinek’s take home message is that inspirational people communicate from the inside out; they convey what they believe. Dr. King, for example, said, “I have a dream,” not “I have a plan.”

In addition to Sinek’s concept, there are three important T’s to consider when sending a message: tone, timing and truth. The message has to be delivered in a tone that is appropriate for the setting and the personality of the recipient. Too harsh or too meek, and the information is cast into limbo. The tree falls but does not make a sound.

Timing is crucial as well. If the message goes on too long, is too brief or is delivered when the recipient is not physically or emotionally receptive, the potential for misinterpretation increases.

The requisite third T should be evident by now. Once, while prepping for a deposition, I asked my attorney how I should answer questions. He recommended telling the truth “because it is easier to remember the truth.” Unless there is truth in the message, there is no chance for effective communication.

All three T’s came together for me last week. As I briskly walked the noisy corridors of a local mall on a busy Saturday afternoon, up ahead I noticed a young person in a motorized wheelchair with her family. As she got closer and eventually passed me I recognized her as the teenage version of a little girl who had beaten a horrific infection with the help of numerous health care providers, including me. She cheated death but at the cost of three limbs. It had been years since I had seen her, and although my role in her care was peripheral by comparison, her strength, courage and positive attitude have always inspired me.

In the cacophony of that noisy mall time stood still as our eyes met. I told her who I was and how inspiring she is to me. She smiled and we hugged.

That was a moment of confluential truth.

Every day we are presented innumerable opportunities to communicate. Never take for granted this precious gift. Tone, timing and truth are all important, but truth is the foundation. The process by which an individual’s unconscious truth becomes conscious thought and can then be communicated effectively to another is among our most important functions as a species and perhaps our greatest attribute as well.

I need a hug.

 

Note: This was my President’s eVoice from The Greater Louisville Medical Society’s October 2013 “Louisville Medicine.”

http://archive.constantcontact.com/fs105/1101098564175/archive/1115193404761.html

Recapping National Substance Abuse Prevention Month 2013

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October 2013 was National Substance Abuse Prevention Month. For thirty-one consecutive days I Tweeted on the subject of substance abuse prevention. Various topics were explored. By doing this I not only learned a great deal about the issues, but also learned there are many people passionate about changing the tide of this epidemic. I am more hopeful than ever.

Here is a recap of National Substance Abuse Prevention Month 2013:

Tuesday

National Substance Abuse Prevention Month Day 1

Since October is National Substance Abuse Prevention Month I am going to message every day this month on TWITTER (@jamespmurphymd). I am inviting you to “follow” me on TWITTER and pass it on to friends and anyone whose life is touched by the plague of substance abuse (i.e. pretty much all of us). Together we can be the change.

http://www.ncadd.org/index.php/programs-a-services/overview

Wednesday

Here’s a goal for DAY 2 of National Substance Abuse Prevention Month…

Check your VITAL SIGNS. Below is a link to our GLMS publications (all are worthy) but Vital Signs Issue 3 – 2012 “Pain Treatment and Prescription Drug Abuse in Kentucky” is particularly timely this month.

https://www.glms.org/Default.aspx?PageID=139

Thursday

It’s DAY 3 of National Substance Abuse Prevention Month.

Surprised to learn that more than 70 percent of people who abuse pain meds get them from friends or family? YOU can make a difference by LOCKING your meds and DISPOSING of the leftovers properly. Here’s how…

http://www.fda.gov/downloads/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/UnderstandingOver-the-CounterMedicines/ucm107163.pdf

Friday

It’s day FOUR of National Substance Abuse Awareness Month.

THE HEALING PLACE benefit concert with jazzy Sarah Stivers is TONIGHT at Kentucky Country Day’s Performing Arts Center. Chill out and support Louisville’s Healing Place – the most successful addiction recovery program in the USA. Help restore lives!

http://www.thehealingplace.org

Saturday

It’s National Substance Abuse Prevention Month DAY 5.

Teens & young adults are most vulnerable to addiction. It’s a brain thing. Learn why. Take action. Is there someone in your life who needs to hear from you?

http://teenbrain.drugfree.org

Sunday

Day 6 of National Substance Abuse Awareness Month

“Requiem For A Dream,” is possibly THE most powerful movie EVER about the downward spiral of drug addiction. The trailer alone will give you chills.

http://www.youtube.com/watch?v=jzk-lmU4KZ4

Monday

National Substance Abuse Prevention Month Day 7

An Open Letter to the Medical Licensing Board of Indiana:

https://jamespmurphymd.wordpress.com/

Tuesday

National Substance Abuse Prevention Month Day 8

“The mission is definitely not accomplished” (see last paragraph). But there is progress. Together we can overcome this foe. Thanks to Laura Ungar and the Courier-Journal for shining a light on the tragedy and the hope:

http://www.courier-journal.com/article/20131007/PRIME01/310070002/Fatal-drug-overdoses-rank-high-Kentucky-do-efforts-combat-problem?source=nletter-top5

Wednesday

National Substance Abuse Prevention Month Day 9

Prescription drugs are now the most commonly abused drugs among 12 to 13 year olds! Parents, today is a great day to take action. Safeguard your medications & TAKE THE PLEDGE at:

http://medicineabuseproject.org

Thursday

National Substance Abuse Prevention Month Day 10

How can your doctor help you avoid being addicted to your pain medications? It helps if your doctor knows how to juggle. I explain here:

http://www.courier-journal.com/article/20120604/NEWS01/107100009

Friday

National Substance Abuse Prevention Month Day 11

Do you know what addiction really is?  A brain disorder? Bad behavior? A disease? Nora Volkow, MD, our nation’s chief #addiction researcher explains. Thank you HBO for a great webpage:

http://www.hbo.com/addiction/understanding_addiction/18_what_is_addiction.html

Saturday

Substance Abuse Prevention Month Day 12

It’s time for one of Marlyce’s cupcakes. Here’s a sweet story about turning tragedy into triumph!

http://kix.com/realizing-a-dream-and-honoring-two-lives/2012/10/

Sunday

National Substance Abuse Prevention Month Day 13

What can Gollum teach us about the disease of addiction and, more importantly, the treatment?

http://www.stratusemr.com/blog/?p=1070

Monday

National Substance Abuse Prevention Month Day 14

“Clean” by David Sheff is an important book that’s easy to read – hard to stomach – impossible to ignore. Hear the author’s moving NPR interview:

http://www.npr.org/2013/04/03/175939127/a-father-tells-the-story-of-his-sons-struggle-to-stay-clean

Tuesday

National Substance Abuse Prevention Month Day 15

Dr. Murphy talks pain and addiction with Dr. Wayne Tuckson on KET:

http://www.ket.org/cgibin/cheetah/watch_video.plnola=KKHEA%20000902&altdir=&template=

Wednesday

National Substance Abuse Prevention Month Day 16

Why does the pain doc make you pee in a cup? It may be random, but that’s how I roll…

http://www.practicalpainmanagement.com/treatments/pharmacological/opioids/tumblin-dice-why-does-random-matter?page=0,1

Thursday

National Substance Abuse Prevention Month Day 17

Don’t let KASPER spook you! (Louisville Medicine, page 20). Read about Kentucky’s powerful weapon in the battle to prevent substance abuse.

https://www.glms.org/Content/User/Documents/Louisville%20Medicine/LM%202012/GLMS%20Mag%20Jan%202012.pdf

Friday

National Substance Abuse Prevention Month Day 18

October also means Halloween. Is this poem a trick or a treat? You decide. (This could be my favorite post of all time!) “How the Ghost Stole Pain Care”.

Saturday

National Substance Abuse Prevention Month Day 19

Heroin is on the rise. Substance abuse will never stop unless we get serious about treating addiction as the disease that it is. Thanks to WDRB for spotlighting this issue.

http://www.wdrb.com/story/23721259/heroin-problem-getting-worse-in-louisville

Sunday

National Substance Abuse Prevention Month Day 20

Joe Elliott and I talked addiction, prevention, treatment and pain management on his radio show:

https://docs.google.com/file/d/0B2PLAYRyZSJjYVRVSGxUVHJxbkk/edit?usp=sharing

Monday

National Substance Abuse Prevention Month Day 21

Get rid of prescription drugs and heroin use skyrockets. Stop heroin use and what takes its place? In Russia it was Krokodil. This drug is cheaper, more potent, and more deadly than heroin and is coming to a town near you! Unless… Please do something to prevent substance abuse today. A drug has never killed anyone. The disease of ADDICTION kills. Warning, viewing this link is not for the meek:

http://www.huffingtonpost.com/2013/10/09/krokodil-drug_n_4073417.html

Tuesday

National Substance Abuse Prevention Month Day 22

With only two pain specialists per 100,000 veterans & with the majority of new VA patients needing pain care, the system is going to be even more overloaded. There are too many overdoses already! Our veterans deserve better.

http://www.cbsnews.com/8301-18563_162-57603767/veterans-dying-from-overmedication/

Wednesday

National Substance Abuse Prevention Month Day 23

In the majority of states drug overdoses kill more people than auto accidents, but this legendary NASCAR driver may have died as a result of not having enough pain medication.

http://espn.go.com/racing/nascar/cup/story/_/id/9286940

Thursday

National Substance Abuse Prevention Month Day 24

Molly,” the adulterated-hit-or-miss-knock-off “Ecstasy” (MDMA), is dangerous, causes seizures and deaths – your body and brain burn from the inside out!   Antidepressants, migraine meds, pain meds, seizure meds – and numerous other drugs that increase SEROTONIN – DON’T MIX WITH MOLLY. Halloween is coming & parties are happening.  Please don’t invite Molly. It’s better to dress up like a ghost than to become one.

https://www.deadiversion.usdoj.gov/NTBI/NTBI-PUB.pub?_flowExecutionKey=_c77D951BD-7482-5753-CD82-9A32810403A6_k55C9A193-AF37-0CF4-CB6F-4AB7143858AB

http://www.forbes.com/sites/robertglatter/2013/09/02/recent-concert-deaths-highlight-dangers-of-molly

http://www.nytimes.com/2007/02/27/health/27brody.html?_r=0

Friday

National Substance Abuse Prevention Month Day 25

Tomorrow you can turn in your leftover meds. It’s National Prescription Drug Take-Back Day.  This is a great way to do something positive for your community, your loved ones and yourself. Most abused prescription drugs don’t come from doctors, pharmacies, or “the street.” They come from family, friends and acquaintances. Just go to the link below and put in your zip code to find a take-back location near you.  What’s in your cabinet?

https://www.deadiversion.usdoj.gov/NTBI/NTBI-PUB.pub?_flowExecutionKey=_c77D951BD-7482-5753-CD82-9A32810403A6_k55C9A193-AF37-0CF4-CB6F-4AB7143858AB

Saturday

National Substance Abuse Prevention Month Day 26

Lots of #Halloween parties tonight! Have fun and be safe. NO drinking & driving.  These #zombies know what I mean…

http://zombiesagainstdrunkdriving.com

Sunday

National Substance Abuse Prevention Month Day 27 Buprenorphine can effectively treat opioid addiction. Learn about it here:

http://www.youtube.com/watch?v=dHAj4ibyUkI#t=41

Find a doctor here:

http://buprenorphine.samhsa.gov/bwns_locator

Monday

National Substance Abuse Prevention Month Day 28

One-fourth of U.S. students have intentionally abused a common household product to get high by the time they reach the eighth grade http://www.inhalant.org. “Huffing” and can kill your child instantly. Every parent needs to watch this:

http://www.nydailynews.com/news/national/student-14-dies-huffing-incident-article-1.1295298

Tuesday

National Substance Abuse Prevention Month Day 29

The most dangerous drugs? The answer may surprise you

http://www.youtube.com/watch?v=DlUS0RlFC4k.

So if availability = danger, then do we really want to legalize recreational marijuana?

http://www.hbo.com/addiction/adolescent_addiction/221_marijuana.html

Wednesday

National Substance Abuse Prevention Month Day 30

Do we have to worry about our kids’ Halloween candy being tainted? Apparently not too much, but there are still some things parents should do before the little ones take a bite:

http://recipes.howstuffworks.com/menus/candy-tampering.htm

Thursday

National Substance Abuse Prevention Month Day 31

Overdose is now the leading cause of injury death in the USA. Read that statement again… and resolve to save lives. Call your legislators: http://www.usa.gov/Contact/Elected.shtml & support “Good Samaritan 911” laws:

http://www.youtube.com/watch?v=tPANxkNwHM8

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