Discover and read the best of Twitter Threads about #Opioid

Most recents (24)

I can’t.
Do they not realize that pulling individuals from #opioid medications also causes suicide ideation and attempts?
#Paincare in the US is awful. Maybe there are pockets where quality care can be accessed but as a caregiver and advocate for many w #hereditarypancreatitis 1
it’s inadequate, stigmatizing and traumatic. I am tired of waiting. I witnessed the traumas my husband and kids went thru and my hope was to raise awareness that others would not have to suffer the same. The #CDC as well as other entities imo has put the horse 🐎 b4 2/
the cart. Why not look at developing options have less risks instead of trying to gaslight those that have found relief and QoL thru LTOT. Quite honestly it’s a ‘cluster’ and not getting better. I understand that there are wide variances of pain and intensities 3/
Read 5 tweets
@DrTomFrieden With all due respect, Dr. Frieden, why didn't you follow science when you directed @CDCgov & you learned in 2018 that fatal overdoses went up, not down, following implementation of the 2016 #Opioid Guideline you promoted? ncbi.nlm.nih.gov/pmc/articles/P…
@DrTomFrieden @CDCgov #CDC-funded research in 2018: “declines in these opioid prescribing metrics ... have not been followed by decreases in opioid overdoses. Instead, overdoses due to illegal opioids ... have increased.” Why didn't CDC retract the Guideline when it saw deaths were going UP?
@DrTomFrieden @CDCgov In 2016, #CDC Director Frieden told the press that the risks of rx #opioids would outweigh benefits for "vast majority of patients.” But the Guideline itself said an average 96% of patients had no addiction or non-addictive abuse, misuse, or long use.
cdc.gov/media/releases…
Read 15 tweets
I don’t know what to say. There are several efforts in #NorthDakota to target those that both #prescribe or #medically benefit from #opoioidpain meds. Just over a year ago many were abandoned, left with no physician. Many are still suffering today bc they 1/
have been denied #opioid #pain #meds & there is no access. Both my kids benefit. It’s the ONLY treatment that has helped. I have reached out multiple times to @FirstLadyND, to our human service department to multiple players and all I get is denial regarding the harms to those /2
those that have benefited from #opioids. I can point out so many efforts focused at decreasing #SUD that focuses on those that benefit from #opioids. This has caused lack of access, suffering, depression and #suicide attempts. Just recently our @DougBurgum announced 3/
Read 9 tweets
1/Canadian provinces that reduced #opioid prescribing the most also had the LARGEST increases in opioid overdose mortality in the 2-year period of 2016-2018 (r=0.63, p=.05, df=8) -it's striking to see significant correlations with n=10! bmcpublichealth.biomedcentral.com/articles/10.11… Image
2/The authors suggest that reductions in prescribed opioids create "supply gaps" that push the *non-medical opioid users* to riskier supplies.

However, I've become more concerned that some actual medical users (i.e. pain patients) also make that jump... like this:
3/In this Colorado case-control study, chronic opioid recipients who later developed new-onset heroin use were more likely to have had their prescription opioids stopped (38%) compared to those who didn't develop heroin use (22%) - sciencedirect.com/science/articl…
Read 8 tweets
One of our local Universities received a grant to implement #OneRx. I find the actions that they encourage highly alarming & stigmatizing. 1) approach patient to discuss only partial fill on #opioid medication 2) provide naloxone (ok with this), 3) refer to MAT 1/ Image
My kids see a team of physicians who know their medical issues. Their issues are complex. I am not sure what I would do if a #pharmacist approached the kids to engage in discussion of only partially filling meds or referring to #MAT. It’s as though there is no understanding 2/
that most on #opioids have seriously tried other modalities of treatment. What will it take to have a balanced narrative instead of one completely #stigmatizing & #shaming 3/
Read 4 tweets
0.1% = rate of fatal #OD in the medical use of #opioids acc'g to 2019 research from Kaiser Permanente (link below).

Bwn 2006-2014, 41 of 31,142 died of OD, a rate of 5 per year. Risk stratification did not lower OD rates. Dose reductions were "inconsistent" (VonKorff). /thread
2,887 #vets died by #overdose or #suicide after their #opioid medicine was stopped by the VHA in FY2013 (90 fewer than on 9/11) (Oliva et al 2020).

Patients whose rx opioid was stopped were 3 times MORE likely to die by OD than those whose medicine continued (James 2019).
4.9% of discontinued patients died of OD.
1.7% of continued patients died of OD.

Discontinuation of rx #opioids was associated with 1.35 times the risk of death & 2.94 times the risk of fatal OD compared to patients whose rx continued (James et al 2019).
Read 12 tweets
#Opioid tapering is "extremely difficult" for people w/ #ChronicPain, "not only in those w/ problematic opioid use."

Kurita: Worsened pain &/or function led more than half of those studied to stop scheduled dose reduction of 10% or 20% per week. /thread onlinelibrary.wiley.com/doi/full/10.10…
1b/ Kurita: Altho 40 of 75 didn't complete the taper, researchers found "improvements after opioid treatment stabilization was achieved," suggesting stabilization (whether at a dose or at 0 dose) is a preferable goal to forcing everyone off rx #opioids.

Stopping can be fatal.
2/ Glanz: "Attempts to adhere to prescribing guidelines may lead patients to be exposed to variability in #opioid dosing." Dose variability of 30% or more increases the risk of overdose more than 300%.

Glanz et al. JAMA Network Open. 2019;2(4):e192613.
jamanetwork.com/journals/jaman…
Read 16 tweets
🔴 Senate #Republicans have KILLED 400 bills passed by the House, most w/ GOP votes. #Dems need to win 4 seats (3 if #Harris is VP). 6 races are tossups: CO-Gardner, GA-Perdue, IA-Ernst, ME-Collins, MT-Daines, NC-Tillis.

thread: Bills Killed by Senate GOP newsweek.com/mitch-mcconnel…
🔴 BIPARTISAN Bills PASSED by the House but KILLED by Senate #Republicans:

Climate Action Act
Raise Minimum Wage
Violence vs Women Act
Corporate Transparent Act
Enhanced Background Checks
Gold Star Family Relief Act
Save the Internet Act
Equality Act
🔴 BIPARTISAN Bills PASSED by the House but KILLED by Senate #Republicans #2

Paycheck Fairness Act
Protect Preexisting Conditions Act
Lower Prescription Drugs Act
Ban Offshore Drilling Act
Invest in Maine Street Act
Lower Prescription Drugs Act #2
#STEM education
Read 45 tweets
#PBM
Pharmacy Benefit Managers have undoubtedly created barriers 4 patients w #ChronicPain #intractablepain #PalliativeCare #RareDiseases w medical necessity for #opioid analgesics. Citing CDC GLs & going even further. This ex shows 67% decrease in Rxs.
benecardpbf.com/PBF/resources/…
All PBMs do something of this nature & plans vary. They should look for & prevent abuse & fraud, but as outlined in their own literature on policy, Benecard is absolutely interfering btw Drs & patients by using CDC GLs & unilateral decisions on what is appropriate for a patient.
Per CDC, based on their clarification of intent of #opioid guidelines; these policies meet definition of misapplication & misinterpretation. Being as @CDCgov @CDCInjury neglects to intervene in official capacity; PBMs, #healthcare insurance companies will continue this practice.
Read 5 tweets
#PainGang #RahRahRah to @OldHeadFighta & NH Pain Collaborative for their BIG WIN in getting protections for pain patients & prescribers into state law. I'll put a sample letter together so folks can lobby their state lawmakers using the NH bill as a model.
NEW NH bill "requires doctors/pharmacists to consider the 'individualized needs' of pain patients, treat them with dignity, and ensure that they are 'not unduly denied the medications needed to treat their conditions.'" #cpp #opioids painnewsnetwork.org/stories/2020/8…
Read 8 tweets
#Opioids "significantly" reduce pain by approximately 30% "regardless of type of pain &/or type of #opioid," acc'g to 10 systematic reviews cited by Volkow, Benvenists, and McLellan in the Annual Review of Medicine. 2018 Jan 29;69:451-65. #cpp /thread medicinainterna.net.pe/sites/default/…
"Improvements in functional status [from the use of rx #opioids] were not as consistent nor as great in magnitude as the analgesic effects, although this was confounded by the lack of standardized measurements."

See Chou et al. 2009 J of Pain 10(2):113–30.
Citations for the 10 systematic reviews on rx #opioid effectiveness. Most are probably available in full text. Paste citation into scholar.google.com.
Read 8 tweets
Still struggling with the wording of this invitation. ‘#COVID-19 has exacerbated the raging #opioid crisis driven by the nation’s more than 50 million #pain suffers......’. I have contacted both @RepJudyChu & @RepWalorski office to express my concern & to 1/ Image
attempt to understand why the blame for the #opioidepidemic seemed to be placed at the feet of those that have #chronicpain. In the past years the # of #opioid pain medication prescriptions have plummeted yet rates of overdose climbed. Many individuals with #chronicpain 2/
who benefitted from treatment from #opioids have been pulled off & abandoned; their #QoL decreasing & suffering increasing. My kids & my husband were/are part of the 50 million that experience/experienced #chronic pain due to #hereditarypancreatitis & #pancreascancer 3/
Read 5 tweets
Chasing Heroin - America’s #heroin and #opioidcrisis has been called the worst drug epidemic in U.S. history. (Question "what is the relationship between #NATO invasion into #Afghanistan and the sudden 8-fold spike in heroin harvest😉". Cui Bono? 🤓)

#sackler #opioid #crisis
The Sackler 🕎-Family 🇮🇱 – A Secretive Billion Dollar #opioidcrisis Empire
With over 200,000 deaths caused by Opioids, are they in jail yet?

threadreaderapp.com/thread/1211761…
#antisemitisme van Rudy Guliani? & Leo Lucassen
Rudy, advocaat van Purdue Pharma, Sackler🕎Family, verantwoordelijk voor honderduizenden doden. Purdue was ook rijke sponsor van de @UniLeiden, een werkgever van Leo Lucassen😉

organisatiegids.universiteitleiden.nl/stichtingen/st… Image
Read 12 tweets
This makes me so furious. I don’t know what has to be said to make individuals aware that #opioid #pain meds benefit many. I don’t ever condone violence, ever, yet try to put yourself in inds shoes who have benefitted from #opioids & their QoL has improved. Many of these 1/
Individuals have had medications ripped away due to #CDC, #PROP, the misapplication of #CDC guidelines, anti opioid advocates (that advocate for OTHER opioids). Let’s have a balanced approach. Peoples lives have been harmed. Not just theirs but their families 2/
This is #PainAwarenessMonth & it’s been a struggle seeing so many who do not and will not understand the experience of many with #chronicpain. For those throwing around ‘there are many non opioid options’ no, there are not & most of the time those on opioids have already tried 3/
Read 4 tweets
#StopTheStigma
#PainAwarenessMonth
The number of #patients with #chronicpain being harmed due to false narratives re #opioid #pain medication continues even while #CDC revisiting guidelines as they know it has been misapplied & manipulated by anti opioid entities 1/
Untreated #pain does harm in so many ways. Imagine a mother having to beg for her child not to have to lie withering in a hospital bed in pain due to #hereditarypancreatitis. Being told to have her daughter use #GuidedImagery to address the horrible pain. This is criminal 2/ Image
Imagine having your children begging to just die due to pain. This has been common for many kids w #pancreatitis due to lack of addressing their #pain. #EssentialOils, #GuidedImagery, #Accupuncture will NOT work in the middle of a flare. It is criminal that this still occurs 3/
Read 3 tweets
Our governor just addressed prescription #opioid abuse with over 3,000 people watching. I am furious. He perpetuated the narrative that opioid pain meds bad and changed brain 🧠 chemistry and highly addictive. We are struggling in our state and our Governors wife 1/
huge advocate for those with #SUD which is great but she is hurting those that have #chronicpain perpetuating the narrative of #PROP and bc of that so is our governor. Most #physicians will not prescribe. The stigma of those inds in ND that have benefitted from 2/
opioid pain meds is huge. So many have reached out to her for discussion but we have not been included. I am furious right now. We have been excluded from this conversation. We are continually being harmed. So mad #RecoveryReinvented in my opinion while assisting those 3/
Read 4 tweets
⭐️ HUGE⭐️ victory for people with #ChronicPain in #NewHampshire AND their doctors. New bill protects the right of #pain patients to #opioid medicines AND protects the doctors who prescribe them.

Bill is MODEL legislation for other states. /thread painnewsnetwork.org/stories/tag/Ne…
New NH law: If people "on a managed and monitored regimen of #opioid analgesic treatment" have "increased functionality and quality of life as a result of said treatment," the "treatment shall be continued if there remains no indication of misuse or diversion.”
Under the new law, "physicians & pharmacists are required to consider the 'individualized needs' of #pain patients, treat them with dignity, & ensure that they are 'not unduly denied the medications needed to treat their conditions,'" including (specifically) #opioids.
Read 12 tweets
@ProjectECHO I just wanted to share that as a #caregiver of two adult children with #chronicpain these screen shots feel incredibly biased. I have watched my husband & my children experience #stigma by medical professionals due to the fact they had/have #chronicpain 1/ ImageImage
my husband passed due to his illnesses #pancreascancer #hereditarypancreatitis. My kids live each day in #pain. We have tried many other options, some of which actually have caused life long injury. #Opioid pain medications have provided them some QoL. They have often 2/
been questioned if the pain is really that bad? Curious if you teach about malabsorption issues? Both my kids have them. Unfortunately due to lack of knowledge (even though throughout chart) about malabsorption in relation to all medications she has been accused 3/
Read 8 tweets
🔴 POLITICAL CAMPAIGNS: STOP our medicine as a prop in your ads. #ChronicPain patients (including literally thousands of #vets**) are dying after being forced off rx #opioids. Medicine is NOT the cause of the OD crisis: illegal drugs are.

** Link to study about dead vets below Image
Stopping rx #opioids to protect people from OD risk of less than 1/4 of 1% increases the risk of death by as much as 6.8 times. VA-funded 2020 study found 2,887 #vets died from OD or suicide after their med was stopped in FY2013, just 90 fewer than 9/11. bmj.com/content/368/bm…
.@MajorityPAC: Millions of Americans are suffering needlessly from uncontrolled pain because policymakers wrongly blamed ODs on #opioid medicine. We're LIVID. Everyone who loves us is LIVID.

🔴 Your candidates will lose voters if your ads treat our medicines like props. #cpp
Read 4 tweets
82 people volunteered to taper rx #opioids. In or by the 4th month, 38% dropped out. They were excluded from results. The finding that "Neither pain intensity nor pain interference increased with opioid reduction" is based ONLY on the 62% who stayed in, not all 82. (1/5)
The outpatient study was 4 months long. Oliva (BMJ 2020) found post-discontinuation deaths (OD/suicide) are highest in the 1st 3 months. I assume researchers checked to see whether anyone died, but it's not mentioned in the paper. (2/5)
Here's what the study actually found: For the 62% who successfully tapered, neither pain intensity nor interference increased w/ rx #opioid reduction. No information is available about why 38% of participants did not successfully taper or dropped out. (3/5)
Read 6 tweets
Risk of OD in medical use of #opioids is highest in doses ≥100 MME but still less than one quarter of 1% (0.23%).

Canadian Guideline for Opioid Therapy (2017)

thread: 3 studies on #suicide, OD, & rx opioids
ncbi.nlm.nih.gov/pmc/articles/P…
2009 study: moderate to severe #pain triples the risk of #suicide even in otherwise healthy people "independent of poor functional capacity or chronic medical illness.”

Untreated pain can lead to death by suicide "unnecessarily and prematurely.” jpsmjournal.com/article/S0885-…
2016 VA study didn't find evidence to support the claim that increases in med'l #opioid use lead to increases in intentional OD.
ncbi.nlm.nih.gov/pmc/articles/P…
Read 3 tweets
1/This student of @SMeghani_PhD reports: medical practices want to stop opioids on all patients, or transfer the patients out, but cannot find any other practice to take them. The travesty is both unsafe and remediable
2/The regulatory incentive in play is one that maximizes clinicians’ (and their employers’ and payers’) perception of liability: criminal, regulatory, and bureaucratic, in terms of the amount of uncompensated labor required to continue an #opioid prescription
3/The hope was that Rx reduction would address either causes of addiction or risk of harm. Clearly OD’s haven’t fallen. There’s room to argue that 2019 NSDUH shows hints of ⬇️ in heroin use among 18-25 yr-olds (0.8%▶️0.5%) but cocaine rose. Table 7.11B samhsa.gov/data/sites/def…
Read 12 tweets
The medical use of #opioids did NOT cause the OD epidemic. But so many people believe it did, that in 2019 even @nytimes agreed with #Kolodny that #racism "protected" black Americans because doctors failed to treat their pain effectively. @afrakt /thread nytimes.com/2019/11/25/ups…
NYT 2019: "African-Americans received fewer #opioid prescriptions, some researchers think, because doctors believed, contrary to fact, that black people were more likely to become addicted to the drugs & would be more likely to sell the drugs."
Black Americans are less likely to receive adequate #pain relief, according to researchers, because there's a lingering (#racist) assumption that black people have a "higher pain threshold" than whites.

#BlackLivesMatter in medicine.
Read 16 tweets
2,887 #vets died of overdose or suicide after their rx #opioid was stopped by the VA in FY 2013. That's just 90 fewer bodies than total US deaths on 9/11. Efforts to stem the crisis of ODs to illegal drugs by restricting rx access have failed b/c medical use isn't the cause. 1/3 Image
2019 study projects 1.21 million will die in US 2015-25 of #opioid ODs AND it explains that rx restrictions aren't just failing to help: they're making the problem worse.

It's obscene.

People w/ #ChronicPain AND w/ #addiction are suffering under a policy that's KILLING us. 2/3
.@headsUPmigraine fights for evidence-based rx #opioid policies that treat people w/ #addiction & #ChronicPain individually, effectively & non-fucking-fatally.

We're looking for partners who advocate for people w/ addiction &/or for #vets (#veterans). threadreaderapp.com/thread/1295072…
Read 3 tweets

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