OPIOID Possibilities are Limitless


“What am I supposed to do? I’m over the limit.”

Recently I was visited by a patient “warrior”. I hadn’t known her before, but she had read one of my articles online and wanted to meet me.  I was touched. There in the foyer of our surgical center, she motored up in her electric scooter and smiled the genuine smile of a person seeing a long lost friend.

Are there limits to friendship? No.
Are there limits to prescribing opioids for pain? Maybe.

At the vortex of misinformation swirling around pain regulations is the fact that no state has limited what physicians are allowed to prescribe, although some states make it unwieldy to treat legitimate pain patients compared to other states; some set unsubstantiated quantity limits while others require consultation to a pain specialist if a predetermined (yet not scientifically proven) “morphine equivalent dose is prescribed”.  Nevertheless, no states unilaterally prohibit a prescription at any dose if the regulations are followed.  However, requiring a pain specialist in some cases may become a logistical nightmare because in most instances there are not enough pain specialists to go around.


To be sure they have created thresholds above which physicians are required to do certain obligatory actions like: drug screens, re-evaluations, treatment agreements, and database queries. But these requirements do not represent ceilings to what can be prescribed – as long as it is medically necessary.

Are these regulatory obligations rational, reasonable, fair, or effective? That is a subject for another article. What is true now, however, is that prescribers are drowning.

“OPIOID” is the acronym used in an upcoming seminar that aims to rescue prescribers from the regulatory maelstrom.

OPIOID picture

“OPIOID” means Optimal Prescribing Is Our Inherent Duty. It is 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.  Clinicians and support staff can register by email: physician.education@glms.org or call: 502-736-6354 or visit online at https://www.glms.org/Home.aspx (and click on the “OPIOID” tab).

My new friend, whose pain had confined her to her motorized chair, wasn’t quite convinced when I assured her that her state’s (Indiana) regulations did not limit what her doctor could prescribe. But in her friendly eyes I saw hope. And her hope gave me strength.

Am I strong enough to climb over the barriers created by these regulations? Are you?

As long as there are patients willing to fight the good fight, then so will I.  And courses like “OPIOID” provide us the tools we need to win. Together, the possibilities are limitless.


James Patrick Murphy, MD, MMM

January 26, 2014

Note: This article was originally posted January 27, 2014 on Dr. Jeffrey Fudin’s blog http://paindr.com/opioid-possibilities-are-limitless-2

The Urgent Need for OPIOID

two tangential universes: therapeutic and pathologic

tangential u darko

In the therapeutic universe suffering is relieved, lives are enhanced, and hope is restored. Central to this universe are the pain care needs of 100 million suffering Americans.

In the pathologic universe suffering is unleashed, lives are enslaved, and hope is shattered.  Ruler of this realm is drug abuse – now killing even more Americans than automobile accidents.

Common to both universes is the prescriber – and the tangent point is OPIOID.

OPIOID picture

OPIOID means Optimal Prescribing Is Our Inherent Duty – a seminar conceived by physicians, approved by the medical board, and produced by the Greater Louisville Medical Society in association with the University of LouisvilleFebruary 7, 8 & 9.

American Medical Association Board Chair (and Kentuckian) Steven J. Stack, MD says:

Physician education on responsible opioid prescribing is a critical element in addressing the epidemic of prescription drug abuse.

Todd Cook, MD, Chief Medical Officer of St. Elizabeth Physicians (Northern Kentucky) says:

This is one of the times when sending a responsible party proactively may provide a great return on the investment for all of us.

Participants in this two and a half day course will gain insight on how to: (a) best prescribe controlled substances for chronic pain, (b) minimize the risks of drug abuse, and (c) safeguard their communities. These goals are achieved through lectures, coaching sessions, and face-to-face interaction with individuals battling addiction.

louisville skyline

Louisville is a point shared by two states (Kentucky & Indiana) that, like many other states, have recently enacted laws to address prescription drug abuse. When such well-meaning laws give legitimate prescribers the chills, a dose of OPIOID is the right prescription.

Finally, an OPIOID epidemic we can all get behind.

Please make it contagious. Pass along this info, refer someone, or even better – sign up yourself.

OPIOID  February 7 – 9, 2014

Register by

Email: physician.education@glms.org

Or call: 502-736-6354

opioid tab

Or visit online at: https://www.glms.org/Home.aspx (and click on the “OPIOID” tab).



Boldly go where no prescriber has gone before.

Take back your universe.

take back universe


James Patrick Murphy, MD, MMM  is President of the Greater Louisville Medical Society.

rx and pen and pad

NIDA & the Facts on Marijuana

The National Institute on Drug Abuse Offers the Facts on Marijuana


From the website:




Use is rampant:

“Marijuana is the most common illicit drug used in the United States.”

brain damage

Has a powerful effect on the brain:

“Marijuana overactivates the endocannabinoid system, causing the high and other effects that users experience. These include distorted perceptions, impaired coordination, difficulty with thinking and problem solving, and disrupted learning and memory.”

Interferes with successful lives:

“Heavy marijuana users generally report lower life satisfaction, poorer mental and physical health, relationship problems, and less academic and career success.”

Damages the brains of young people:

“Research from different areas is converging on the fact that regular marijuana use by young people can have long-lasting negative impact on the structure and function of their brains.”

Permanently lowers IQ:

“A recent study of marijuana users who began using in adolescence revealed a profound deficit in connections between brain areas responsible for learning and memory. And a large prospective study (following individuals across time) showed that people who began smoking marijuana heavily in their teens lost as much as 8 points in IQ between age 13 and age 38; importantly, the lost cognitive abilities were not restored in those who quit smoking marijuana as adults.”

Causes heart disease:

“Marijuana raises heart rate by 20-100 percent shortly after smoking; this effect can last up to 3 hours. In one study, it was estimated that marijuana users have a 4.8-fold increase in the risk of heart attack in the first hour after smoking the drug.” 

car wreck

Causes car wrecks:

“A recent analysis of data from several studies found that marijuana use more than doubles a driver’s risk of being in an accident.”

Damages the lungs:

“People who smoke marijuana frequently but do not smoke tobacco have more health problems and miss more days of work than nonsmokers, mainly because of respiratory illnesses.”

Causes psychiatric illness:

“A series of large prospective studies also showed a link between marijuana use and later development of psychosis. Associations have also been found between marijuana use and other mental health problems, such as depression, anxiety, suicidal thoughts among adolescents, and personality disturbances.”


Damages babies:

“Marijuana use during pregnancy is associated with increased risk of neurobehavioral problems in babies. Consequences for the child may include problems with attention, memory, and problem solving.”


Is NOT a legitimate medicine:

“The FDA requires carefully conducted studies in large numbers of patients (hundreds to thousands) to accurately assess the benefits and risks of a potential medication. To be considered a legitimate medicine, a substance must have well-defined and measureable ingredients that are consistent from one unit (such as a pill or injection) to the next.”

Is definitely addictive:

“Contrary to common belief, marijuana is addictive. Estimates from research suggest that about 9 percent of users become addicted to marijuana; this number increases among those who start young (to about 17 percent, or 1 in 6) and among daily users (to 25-50 percent).”

And is more potent that ever:

“The amount of THC in marijuana samples confiscated by police has been increasing steadily over the past few decades.”

Read more:  http://www.drugabuse.gov/publications/research-reports/marijuana-abuse

drug facts week

Dr Gupta, Seriously?

04C No truth sign

On December 21, 2013 at 12:28 am, in response to a story on Anderson Cooper 360 by CNN’s Chief Medical Correspondent Dr. Sanjay Gupta, about Dr. Lynn Webster,  I posted the following comment. 

December 19th, 2013 10:00 PM ET

Pain doctor investigation

Dr. Gupta, seriously?

You know that treating chronic pain is challenging. There is no pain “thermometer” or lab test to measure, monitor, or prove pain.  It is inherently personal and subjective.  Your implied dismissal of a mode of therapy (i.e. opioids) just because it is not “proven,” smacks of hypocrisy.

You know physicians offer treatments every hour of every day that have not been proven by ivory tower standards (e.g. Many of the drugs used in Pediatrics have only been researched in adult studies and are not FDA approved for children).  Medicine is as much art as it is science. At the end of the day, it comes down to the caring personal connection between the physician and the patient – understanding that the outcome is not guaranteed.

My knowledge of Dr. Lynn Webster is indeed that of a caring, expert, and passionate physician. I wish he could have given his candid opinions, but (again, you know) when there is a lawsuit the doctor is advised to keep silent.

Your CNN piece was anecdotal, unconvincing, sensational, and seemed like “gotcha” to me. I expect better from CNN and you.

Opioid therapy for chronic pain is not without risks.  Dr. Webster has been part of the solution exponentially more than he has been part of the problem. One-sided stories (like yours) cause harm by keeping silently suffering pain patients in the shadows and by discouraging physicians (like Dr. Webster) from taking on the challenge of chronic pain care.

Dr. Gupta, you have such an influential platform. Don’t give in to sensationalism.


James Patrick Murphy, MD, MMM

Certified, American Board of Pain Medicine
Certified, American Board of Anesthesiology
Subspecialty Certified in Pain Management
Certified, American Board of Addiction Medicine



re re re

RE – view               RE – vise                 RE – fer 

December 12, 2013 – Counting today there are four days until Indiana’s Emergency Pain Regulations go into effect (on Sunday, December 15, 2013).

The Painful Truth (my opinion) today examines section NINE.

SECTION NINE  – When the morphine equivalent dose (MED) is more than 60 mgm/day, it’s time to REVIEW, REVISE, & REFER

When the 60 mgm per day MED threshold is exceeded, the following must be done:

  1. A face-to-face REVIEW of the treatment plan.
  2. Document a REVISED ASSESSMENT & PLAN  – including risk of DEATH.
  3. Consideration of REFERRAL to a “specialist.”

The Painful Truth notes that the main goal of the “revised” plan seems to be mitigation of risks (especially DEATH) associated with higher opioid dose regimens.

The Painful Truth notes that while the non-specific wording (i.e., “revised,” “consideration,” and “specialist”) allows application of a physician’s clinical judgment, it remains important that documentation adequately justify therapeutic decisions.

The Painful Truth recommends addressing the increased risks (including death) associated with MED greater than 60 mgm/day in a combined opioid INFORMED CONSENT & TREATMENT AGREEMENT (see section FIVE).

The Painful Truth has already examined the concept of a morphine equivalent threshold (see section TWO).