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


Or call: 502-736-6354

opioid tab

Or visit online at: (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

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).