SOUTHERN INDIANA — Right around the time Dr. James Patrick Murphy opened a pain management center in Louisville, the medical community was introduced to a class of drugs that would later be tied to a national epidemic.
It was the late 1990s and long-lasting pain relievers like Oxycontin were taking the stage.
“So, where someone was taking four pills a day, now they could take one pill a day, but it was as strong as four pills,” Murphy explained. “We were told these medications were not as addictive, they were safer and they were effective.”
They were wrong, at least in part.
Well-intentioned doctors, Murphy said, were pressured to treat pain more aggressively. Pharmaceutical companies held conferences to market the new drugs and woo doctors. Around the same time, pain became the “fifth vital sign,” and doctors were expected to treat it like they would high blood pressure.
Unlike blood pressure that can be tested, though, doctors had to rely on patients grading their own pain level.
“So doctors trying to do the right thing would prescribe more of these medications. And as a result, more of the pills were in the community,” Murphy said. “And when more of these pills are in the community, they’re going to eventually end up in the wrong hands. Or someone’s going to experiment with them for the wrong reasons.
“And that happened a lot in the ’90s and the early part of this century.”
By the latter part of the decade, Murphy opened his practice and “treated pain with anything you could think of.” That included acupuncture, epidural injections, physical therapy and, of course, opioid pain relievers.
“I would write medications for the proper reasons and some people would return and want more and more or they’d be out of their medicines early,” he said. “And then I would get letters from people sometimes saying, ‘we know so and so might be abusing their medication.’”
Then came the reports of pill mills, clinics that would take cash in exchange for narcotics, regardless of the medical need.
“Both of these things are going on at the same time and that became almost like a perfect storm to create this prescription opioid problem.”
That’s when Murphy decided to take a step back. He wanted to know more about the opioids he was prescribing. So, he became a certified addiction specialist.
“And when that happened, I realized, okay, there is a whole other reason people are coming to see me for these medications,” Murphy said. “I need to be able to detect this better so I can intervene early and also not to be part of the problem, putting these medications into the communities.”
Laws aimed at cracking down on pill mills were eventually successful. But it also cut off supply without addressing the demand, and that meant people turned to heroin, a cheap and readily available alternative.
Now, almost 80 percent of Americans using heroin report misusing prescription opioids prior to using the street drug, according to the National Institute on Drug Abuse.
And the results are devastating. According to the Centers for Disease Control and Prevention, the number of overdose deaths involving prescription opioids and heroin have quadrupled since 1999. Now, an estimated 90 Americans die every day from an opioid-related overdose.
Murphy, whose practice has since moved to New Albany, said what makes heroin so dangerous is how it affects the brain.
Prescription opioids, he said, attach to receptors in the brain that in turn relieve pain. Some people experience a pleasurable sensation, but not everyone is susceptible, Murphy said. Heroin works in the same way, but is much more potent.
“It goes to the brain so quickly, and these drugs that get to your brain that fast, they can have an intense response in terms of this reward system or this pleasurable thing or this high,” the doctor said. “Those are the most dangerous drugs.”
Even with prescription opioids, someone can become addicted after the first use, though Murphy said it would, more than likely, take several weeks.
“And that hole becomes so deep it can never be filled. And that’s when the addiction is so set in that it’s almost untreatable or it has to be treated very aggressively,” he said.
While Murphy wants people to be aware of the dangers of opioids, he also wants the public to know that pain is a legitimate problem, and opioids can offer a legitimate solution. That’s why his practice still helps roughly 1,200 patients manage their pain.
“The attitude toward opioids with physicians has gone from we know we can treat it to I’m afraid to treat it,” he said. “So we have to make the physicians feel comfortable doing it the proper way and that comes with education.”