LOUISVILLE House Bill 1, (HB1) the Pill Mill Bill from 2012 did not only impact anesthesiologists and pain medicine doctors. The restrictions and requirements of HB1 are felt by any Kentucky physician who prescribes controlled substances for pain or other medical conditions.
Responsible Opioid Prescribing Essentials (ROPE) is a study group created and led by James Patrick Murphy, MD, pain specialist and president–elect of the Greater Louisville Medical Society (GLMS). His program is based on the writings of Scott M. Fishman, MD, Responsible Opioid Prescribing, A Clinician’s Guide, 2ndedition, which is one of the approved CME sources that meets the requirements of HB1.
Murphy presented ROPE twice in February, 2013. Dates for future ROPE courses will be listed on the GLMS website, www.glms.org. The goal of the program, says Murphy, is “to facilitate physicians obtaining the required CME credits and to give them the tools, education, and confidence they need to prescribe chronic pain medications according to current Kentucky law.”
Differentiating “aberrant behavior, abuse, and addiction” is an important factor for physicians, says Murphy. Of the total pain patient population, 40% may demonstrate some measure of aberrant behavior; 20% may abuse their drugs, but only 2%-5% are addicted. In fact, Murphy states “the biggest misconception in pain medicine is that addiction is prevalent among chronic pain patients. It’s not true.” The key for responsible prescribing of opioids by physician is screening for the risk factors, such as past history of abuse, mental health status, family history, peer group, culture, and social environment, he says.
Drug abuse, not taking medications as prescribed, is the most common drug problem in Kentucky. The ROPE program teaches a series of aids for physicians who must “decide to treat or not to treat,” says Murphy, including prescribing a less risky treatment first, employing screening for abuse tendencies and checking KASPER.
Developing a pain treatment plan which addresses the patient’s goals and functionality is critical, says Murphy, and “start low and go slow” with the medications. An “Exit Strategy” and “Function Plan” need to be part of the original plan and discussed in advance with the patient, he says.
The ROPE program addresses many more issues facing physicians who treat patients with chronic pain. The overarching message is for “physicians not to feel alone in this situation,” says Murphy. “There is a way to prescribe opioids and chronic pain medicine safely and correctly that will let you sleep at night,” he says. “I do these things, and I sleep well at night.”
Murphy can be reached at Murphy Pain Treatment Center (502) 736 3636 and dr.m@mpcky.com.