Discover and read the best of Twitter Threads about #Opioids

Most recents (24)

1/Published: “Nonconsensual Dose Reduction Mandates are Not Justified Clinically or Ethically: An Analysis” -In Journal of Law, Medicine & Ethics, with @AjayManhapra @AJ_Gordon. Given the paywall, I’ll offer key points #ChronicPain #opioids
journals.sagepub.com/doi/abs/10.117…
2/Historic context: #Opioid prescribing (peaking in 2012) was part of a crisis we face now. Their embrace reflected a collective failure by payers, educators, and boards who *never fostered expertise in pain, or addiction.* They/we set the table for poor care then, and now
3/Opioid Rx’s began to fall 2012, & that sped up after a @cdcgov guideline that urged caution in dosing, but did NOT require opioid stoppage or taper. CDC’s language was (still is) weaponized by insurers, employers, pharmacies, quality metric agencies
Read 18 tweets
A Google Scholar search for papers about Pain Catastrophizing + #opioids had 2,530 hits since 2018. That's 76.6 times the number of papers in 00-02.

What's "pain catastrophizing"? / thread
The Pain Catastrophizing scale assesses whether people in #chronicpain engage in rumination on &/or magnification of their pain &/or how many feel hopeless.

They claim that "catastrophizing has been associated w/ #opioid craving, long-term opioid use," & misuse.
"Pain catastrophizing has been identified as a risk factor for prescription #opioid misuse in patients with chronic pain generally." Sharifzadeh, Kao, Sturgeon, Rico, Mackey, Darnall (2017). #cpp anesthesiology.pubs.asahq.org/article.aspx?a…
Read 11 tweets
.@BethDarnall designed the questionnaire widely used to diagnose Pain Catastrophizing (PC). She pinned a survey to her twitter pg, asking people in #ChronicPain what they think of the term. Research on PC & rx #opioids is +75 times higher now than in '00-02.

What's PC? / thread
The Pain Catastrophizing Scale measures "rumination (eg, 'I can't stop thinking about how much it hurts'), magnification (eg, 'I worry that something serious may happen'), and helplessness (eg, There is nothing I can do to reduce the intensity of the pain')." [Darnall note 1]
"Psycho-pathology is both an antecedent & a consequence of persistent pain." [note 2]

Pain catastrophizing is "a mental set related to pain that is characterized by feelings of helplessness and persistent and unrealistic beliefs about pain and its consequences." [note 3]
Read 12 tweets
.@VoteVets You're wrong to make rx #opioids the focus of your anti-Collins ad. #Vets taken off rx #opioids are up to 6.8 times MORE likely to die by OD or #suicide than those who stay on, per 2020 VA study. (thread) bmj.com/content/368/bm…
#Vets whose rx #opioid was stopped after 3 months overdosed or killed themselves at nearly 4 times the rate of those who continued to be treated. Those whose med was stopped after 1+ year ODed or killed themselves at 6.8 times the rate of those still treated (Oliva 2020).
2020 VA study: “Studies have identified a rise in adverse events (death from overdose, suicidal thoughts, self-harm, & hospital admissions or emergency department visits
for substance related events) after stopping treatment with #opioids in patients treated long term” (Oliva).
Read 15 tweets
1/My @TEDx talk reached 50,000 views! “We Need to Measure the Opioid Crisis Differently” reflects a shared sense of alarm regarding harm to patients with pain, on #opioids, a stigmatized group whose *safety was discounted* in the US opioid crisis response
2/Because a rise in #opioid Rx’s contributed to opioid use disorder in the US, public health leaders fixated on pills as “vector of disease” and cutting those Rx’s as the key to solving a crisis. And cut we did: opioid Rx/capita are 19% lower than in 2006. cdc.gov/drugoverdose/p…
3/A common risky practice is forced #opioid taper. While we have evidence that ratcheting #opioid dose UP entails risk, we never had evidence that weaning DOWN (with OR without consent) makes them SAFTER. Under real-world conditions, this practice often causes harm.
Read 17 tweets
Opioids, Inc. - Pushing opioids. Bribing doctors. Making millions. FRONTLINE and the Financial Times investigate Insys Therapeutics profited from a #fentanyl-based painkiller up to 100 times stronger than heroin. #Opioids #OpioidCrisis #WallStreet

In NL (2018) waren er 1.028.000 gebruikers van opioïden
Het meest voorgeschreven :
•oxycodon met 454.500 gebruikers
•fentanyl met 104.560 gebruikers
•morfine met 90.491 gebruikers
•buprenorfine met 38.789 gebruikers (Gipdatabank)
opiaten.nl/cijfers-onderz…
The Big Pharma rap by #Insys #Pharmaceuticals- overdose victims


Subsys Rap Video Created by #Insys #Pharmaceuticals (official version)
Read 7 tweets
Brain imaging confirms what your grandmother told you: overworrying makes you feel worse. Treating #anxiety can often ease the burden of #ChronicPain.

Thread: comparing tests that screen for anxiety with & without physical symptoms threadreaderapp.com/thread/1270853…
The Hospital Anxiety & Depression Scale (HADS) doesn't include specific physical symptoms. HADS assesses #anxiety by asking how often a person feels tense, restless, worried, vaguely frightened, or panicked. svri.org/sites/default/…
By contrast, 40% of the items on the 4 Dimensional Symptoms Questionnaire ask about specific physical symptoms, every 1 of which can be indicate #migraine. semanticscholar.org/paper/The-Four…
Read 19 tweets
@CContrarus @hope411adcock @painadvocateAR @tal7291 @fightpaindaily @speakingabtpain @jillyannjiggs @JoeFalzone8 @JSG_54 @LadyAg72 @brent_kellogg @dr4liberty @Irishbrat1966 @ThomasKlineMD @DanLairdMD @D321Debbie @Angelsgal02 @esteckler2 I've been housebound w/ continuous #migraine for 15 yrs, direct @headsUPmigraine, & disagree profoundly w/ overpsychologizing pain.

#Psychologists are wrong to diagnose "catastrophizing" w/ this test w/o telling patients that doctors may use results to taper/deny #opioids.
@CContrarus @hope411adcock @painadvocateAR @tal7291 @fightpaindaily @speakingabtpain @jillyannjiggs @JoeFalzone8 @JSG_54 @LadyAg72 @brent_kellogg @dr4liberty @Irishbrat1966 @ThomasKlineMD @DanLairdMD @D321Debbie @Angelsgal02 @esteckler2 @headsUPmigraine Thread below: @headsUPmigraine's response to "catastrophizing" survey & diagnosis, as well as its "possible predictive value for #opioid prescription" (sec 4: Discussion, Sharifzadeh, Darnall, et al., 2017). ncbi.nlm.nih.gov/pmc/articles/P…
People should be informed if a questionnaire they're given to diagnose a #psychological disorder might potentially be used by a physician to deny them treatment for a physical disease.
Read 18 tweets
FDA HHS CDC all say patient consent should be obtained before tapering rx #opioids except in rare emergency cases. Many drs & hospitals aren't following this guidance. Here's a letter that protected my rx. Please feel to use it or the research it contains: docs.google.com/document/d/e/2…
Federal Health & Human Services tells doctors: "Avoid insisting on #opioid tapering or discontinuation when opioid use may be warranted": "CDC Guideline...does not recommend opioid discontinuation when benefits of opioids outweigh risks."
HHS & CDC both tell doctors to "consider individual patient situations" & to "avoid misinterpreting cautionary dosage thresholds as mandates for dose reduction" when prescribing #opioids.
Read 13 tweets
1/“Due to the increasing demands and changing nature in primary care, we will no longer manage chronic pain” as Mass. patient is told he will “taper off” in 1-2 months: I don’t know the clinic. I know the trend lines reflect impact of making a liability (the patient) unbearable
2/The overprescribed opioids’ role in contributing to problems of diversion & overuse drew a controlling reaction in which the Rx itself was seen as the prime target for reduction, by nearly all parties that could- simultaneously- affect prescribers’ sense of safety to practice
3/Amidst #COVID19 - neither a urine drug test nor an in-person visit are strictly required by existing DEA rules, but DEA rules alone don’t determine the decision framework for prescribing clinicians deadiversion.usdoj.gov/GDP/(DEA-DC-02…
Read 12 tweets
Daily Bookmarks to GAVNet 5/16/2020-2

Technique could enable cheaper fertilizer production

phys.org/news/2020-05-t…
#production #fertilizer
Four years of calculations lead to new insights into muon anomaly

phys.org/news/2020-05-y…
#anomaly #insights #calculations #physics
Researchers identify potential pathway to make opioids safer, more effective

medicalxpress.com/news/2020-05-p…
#opioids
Read 8 tweets
Tweet 1: " Many people ask me why someone on opioid against #treatment (OAT) to manage their #addiction would still use heroin at the same time. It comes down to what fuels on individuals addiction (a thread)"
Tweet 2: "2/ First, you have to understand why someone might start using #opioids or other drugs in the first place. For me, I started using heroin to deal with deep-rooted trauma that was causing me incredible emotional pain"
Tweet:3 "3/ Soon I had to keep using heroin regularly to stave off the debilitating withdrawal from not using. So I was using heroin for two reasons: to manage trauma and to manage withdrawal"
Read 6 tweets
Our latest work published in @PAINthejournal: Attention to Breath Sensations Reduces Pain Independent of Endogenous Opioids.

We dissected components of mindfulness meditation by randomizing folks to a #mindfulness #meditation, sham-mindfulness, + slow-paced breathing group 1/n
This was a double-blinded, randomized crossover designed study where subjects received IV naloxone or placebo-saline during noxious heat (49°C) to determine which aspect of mindfulness (if any) engages endogenous opioids to reduce pain. 2/n
We discovered that mindfulness and slow-paced breathing significantly reduced pain independent of endogenous opioids.

However: Sham-mindfulness meditation reduced pain during saline infusion but analgesia was reversed when we blocked endogenous #opioids 3/n
Read 10 tweets
1/important clarification from AL Med board- initiation of a controlled substance can be done without in-person exam for duration of this declared public health emergency. This partially alleviates pressure on long-term opioid recipients. I’ll clarify why “partially” next
2/The public health issue is 10 mn pain patients on long term #opioids who must repeatedly see their docs in-person to CONTINUE the Rx’s. It is a major risk to them and the health system. Did DEA require that, ever? Not exactly, but in a way EVERY agency influencing opioids does!
3/Docs caring for patients on long term opioids have to guess how to continue the Rx without being subject to suspicion, investigation & rebuke from a variety of actors, including but not limited to law enforcement (quality metrics, insurers). ALL treat continuation as suspicious
Read 9 tweets
Dr. Kertesz addresses the doctors who believe no one should be started on #opioids in this tweet. I'd like to chime in as well.

I believe it should be a carefully thought out decision between doctor & patient. I'm a patient that benefits from #LongTermOpioidTherapy. A few notes:
I finally got a diagnosis that isn't half-assed. I have #EhlersDanlosSyndrome, among other things. It's extremely painful. It started to set in during college. I should have know that wearing a backpack shouldn't have been excruciating. It was. I didn't go on an #opioid regimen
for years, however.

I finally tried #opioids long-term around the age of 28. I was working as a freelance photographer. Hauling equipment around became so painful, I hit a WALL around the age of 30. I had to slow down, whether I liked it or not. I got married, & after that, my
Read 10 tweets
🔴 RT to help us hold @PennStHershey Med Director accountable for false claims about #ChronicPain & rx #opioids on KATU-TV 2/12. She smeared her own patients, spread misinformation, & stigmatized all people in pain. We've asked her to apologize & correct the record. /thread
.@PennStHershey: Why do you have confidence in Dr Delone? A kid in your onco waiting room who reads this
@AmericanCancer brochure has more accurate info than she does.
cancer.org/content/dam/ca…
.@AmericanCancer: “When pain meds are taken the right way, addiction is very rare" ('19).

@PennStHershey Med Director: “We know that these do not make you more functional. They make you addicted and dependent.”
Read 10 tweets
"Most patients do not 'get high' from taking #opioids, & #addiction is unlikely if your risk for addiction is low: those at greatest risk have a history of addiction w/ alcohol or other drugs." — Canadian Guideline for Safe & Effective Use of #Opioids #pain #cpp | thread
Current Canadian Guidelines for Safe and Effective Use of #Opioids for #ChronicPain | Info for Patients:

1) "#Opioids are used to improve your ability to be active and reduce pain." nationalpaincentre.mcmaster.ca/opioid/cgop_b_…
2) "There are side effects from #opioids, but they can be mostly controlled with increasing your dose slowly."

Most common side effects: nausea, constipation, drowsiness, dizziness, itching. (Canadian Rx Opioid Guidelines).
Read 16 tweets
.@MedPageToday Your 3/1 illustration about #opioid tapering is so offensive I won't retweet it. #ChronicPain, not the medicine that relieves it, is the ball & chain millions drag behind us. I direct @headsUPmigraine. I know people who died after being forced off safe med. /thread
Shame on you for perpetuating the stigma & misinformation that's ruining & even ending people's lives. "When #pain meds are taken the right way, #addiction is very rare." #opioids #cpp #spoonie cancer.org/content/dam/ca…
#CDC's Guidelines put the rate of non-problematic use of rx #opioids at average 96.97% w/ 3.03% including non-addictive "dependence." Brat 2018 reviewed 1+ million post-op patients & found rate of 99.4% unremarkable use; 0.6% included patients who refilled, @MedPageToday.
Read 9 tweets
.@BridgeMichigan You gave positive press to BC/BS Michigan's decision to pay doctors 35% more if they don't prescribe #opioids post-op. This thread is a #factcheck.

1) You never mentioned that restricting rx access has failed to curb ODs, which are fueled by illegal drug use.
Jnl of AMA study: Efforts to curb ODs focused on "restricting the supply of prescription #opioids...have failed to demonstrate consistent benefit." Continuing these policies "may have a modest effect, at best."

This is widely known. Your writer didn't know it.
2) A 2017 study looked specifically at rx post-op & found 99.4+% safe use. The 0.6% included people who refilled their rx. You just gave great press to @BCBSM who's paying doctors to leave patients in pain to avoid meds w/ +99.4% safe use. (Citations in report below.)
Read 12 tweets
1) One of my occupational hats includes critical review of the medical literature for drugs or treatments, sometimes to testify as expert witness. What you are doing by trending #Prednisone to demonize a drug when you have NO medical training is murderous.
2) Life threatening diseases frequently involve using drugs with unwanted side effects. You are the same people that, with no biochemical, pharmacological or medical training are demonizing #opioids and physicians, when the (very) American problem is related to ...
3) ... synthetic opioids available in the black market and supplied by the Transnational Criminal Organization Triad in partnership with the Mexican Cartels. American politicians take their 10%, as always.
Read 6 tweets
1/
Hey folks: I wanted to share something @apmresearch just released that I’m very proud of:

Our VOTER PROFILE TOOLS, as part of our broader #RepresentingUS project. (Read: A wealth of data to understand the US electorate in interactive @tableau tools.)
apmresearchlab.org/representingus…
@APMResearch @tableau 2/
We at @apmresearch released these tools on #IowaCaucus day, but expect that they will be valuable up until the #2020election & beyond—to understand how eligible voters differ—often dramatically—from state to state & in each congressional district.

apmresearchlab.org/representingus…
@APMResearch @tableau 3/
Already I’ve read numerous #media stories about the #IowaCaucuses & #NewHampshirePrimary saying those states don’t reflect the nation’s #demographics, but the #journalists didn’t include any data as to HOW they differed and to what degree.
Read 22 tweets
1. The @CDCgov has just released a report showing that life expectancy rose in 2018, for the first time since 2014, inching up to 78.7 years. This followed three straight years of decline marking the tail-end of @BarackObama's presidency. cdc.gov/nchs/data/data…
2.The 3 leading causes of death, heart disease, cancer & 'unintentional injuries' all showed decreases, although the latter, which includes drug overdoses, showed the most proportional decrease. This was the first decline in 20 years of drug-related deaths healio.com/primary-care/a…
3. In fact drug overdoses had increased from 17,400 in 2000 to an astonishing 70,200 by 2017, disproportionately affecting poor communities as well as Americans living in rural areas. 47,600 were from #opioids & 78% of these, classified as White kff.org/other/state-in…
Read 14 tweets
I have a grievance regarding my mom's care during her bout w/#sepsis. #dementia

At the end of October 2019, my husband & I awoke to find mom's breathing labored, & her mumbling to let her sleep. We let her rest. A fever spiked within the hour, & suddenly she became deathly ill.
She was twitching, sweating profusely, in full rigors, & unable to sit up/speak well. She looked TERRIFIED. I thought she had a stroke. Turns out, it was a high fever from an infected gallbladder. She landed in the #ICU. ALL her vitals were jumping around. It was horrible.
She landed in the ER & eventually the ICU. Turns out she had #sepsis from the infected gall bladder. The ICU's 1st step? Changing her meds around INSTANTLY. Specifically they rescinded ALL #opioids abruptly. After over a decade on them, she was thrown into acute withdrawal in ICU
Read 16 tweets
Time for "What's My #ChronicPain Personality Disorder?"

Does continual #pain make you suspect others aren't on your side? Does severe pain make you detach from relationships or restrict your emotions? You have a CLUSTER A Disorder! / thread
When you're in #pain, do you feel excessively emotional & seek attention? ... Congratulations! You're histrionic! (Cluster B)
Does having continual #pain give you an "excessive need to be taken care of"? Join the 17.4% of #CPPs in Cluster C Personality Disorders!

(17.4 strikes me as a little low, peeps. Who's not having enough pain? We should be in the 20s, if not the 30s on this baby.)
Read 12 tweets

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