FEATURE
closed. And many prescribers became terrified of treating pain with
opioids. As a result, patients like John were left with few options. In
other words, John was trapped. In his case, this captivity had gone
on for over 10 years.
But his independence day had come. John found his way to my
office. After about 45 minutes of evaluation, I gave him the good
news: he was not addicted after all. John was not craving or com-
pulsively using or overusing his medications. John was using the
methadone he received in two-week supplies to treat his pain. He
did not have a primary, chronic disease of brain reward, motivation,
memory and related circuitry. In reality, he had developed physical
dependence on methadone, as would anyone who had taken opioids
for more than a few years, regardless of the reason.
Better yet, John didn’t have to go to the methadone clinic any
longer. He could come to see me and be prescribed methadone
pills that are strictly for pain, instead of the little bottles of liquid
Later that evening, during a phone conversation with my col-
league, Dr. Wayne Tuckson, I vented my frustration about this
suffering patient, who had come to me seeking comfort, but left
my office probably more despondent. I certainly hadn’t solved his
problem. And as I told Wayne the story, I began to realize that my
patient and I had more in common than I originally thought.
I had called Wayne trying to garner a unified response to help
patients suddenly left without pain care, through no fault of their
own, due to DEA raids on their pain clinics - a growing unintended
consequence to our current response-to-the-opioid-crisis world.
And as I talked with Wayne, I began to see reflected in my own
patient’s dilemma, the precarious footing upon which I also stood.
I could not solve my patient’s problem, because my patient was not
confident I could solve my own.
He could not be sure that my practice, my profession, my life’s
calling, would survive in the wake of the pendulum’s swing. In the
methadone issued to him every two weeks from the clinic. Oh happy
day! This was great news! end, my patient chose the safe harbor of his fraudulent methadone
clinic over my offer of legitimate pain care, albeit on turbulent seas.
So why did John begin to tremble and tear up when I told him? That experience with my new patient, no less a privilege despite
the foreboding outcome, has left me thinking, “Where will I find
a safe harbor?”
John declined my offer to take over his methadone, even though
it would be covered by his insurance and dispensed in monthly
supplies from a pharmacy of his choice convenient to where he
lives. He thanked me for the news, and he agreed that he was not
addicted. But he looked deflated, defeated.
He told me he couldn’t risk it. It had taken him years to jump
through the hoops at the methadone clinic - the daily visits that
eventually became weekly and then monthly, the requisite number of
“clean drug screens,” the mandatory counseling sessions, and finally
earning the privilege of actually taking home two-week supplies of
the liquid medication. John’s life had become manageable, even if
it was in captivity.
John did not take me up on my offer because he was satisfied
with being labeled an “addict” in order to get some measure of ef-
fective pain relief. He turned me down because he could not accept
the risk that I might not be able to prescribe for him chronically.
He could not risk that I would eventually be closed down or that I
might stop treating pain. He could not risk having to start all over
at the methadone clinic with daily visits. His job, his lifeblood, his
ability to provide for his family, might not survive another reboot
at the methadone clinic.
C
M
Y
CM
MY
James Patrick Murphy, MD specializes in Pain Medicine and Addiction
Medicine, is a past-president of the Greater Louisville Medical Society,
December 2018 Harding Shymanski quarter page ad GLMS.ai 1 11/1/2018 2:45:39 PM
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So, instead of a new beginning, potentially better pain relief and
successful tapering of methadone, I gave John the steroid injection
he had come to me for in the first place. That does not change the
fact that transitioning his medication management to my care was
entirely appropriate. John does not belong in a methadone clinic.
He is not an addict. But he is a prisoner.
Contact Michele R. Graham, CPA, MST
800.880.7800 • www.hsccpa.com
Louisville, KY • Evansville, KY
Parent of HSC Medical Billing & Consulting, LLC
APRIL 2019
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