Discover and read the best of Twitter Threads about #buprenorphine
Most recents (8)
1/ As if the #opioid crisis and the pending #ONhealth ED collapse weren’t enough, @OntariosDoctors section on Addiction Medicine warning OAT clinics across Ontario could see service disruptions as of Dec 1, 2022 (ironically #internationalaids day) 
2/ At issue is the implementation of the new virtual care codes which will slash fees for video consultations with new patients— patients in rural or remote areas without access to specialists are likely to be most impacted. #onpoli #onhealth
3/The irony is that #mentalhealth in #ontario was pioneering in establishing the virtual care capacity that got us through #covid. Many community-based #buprenorphine programs in rural and remote areas operated virtually prior to the pandemic, increasing #accessibility to OAT.
During the pandemic, guidance for #OAT was modified around the world, leading to more flexible access to take-home doses for many people treated with #methadone and #buprenorphine. In our new study in @JAMA_current, we evaluated the impact of these changes on patient outcomes.
We looked separately at ppl treated with #methadone and #buprenorphine, stratified by level of take-home doses before the pandemic (daily or weekly). We then examined how more flexible take-home doses were associated with risk of OAT discontinuation, interruption and #overdose.
Impacts were most prominent among methadone recipients, where receiving new or extended take-home doses led to a lower risk of treatment discontinuation/interruption & a similar or lower risk of overdose.
Last session for me today at @APSAD40 on prescription opioids, treatment, and prescription drug monitoring programs. First up - a mini-symposium with @PPrathivadi , @LouisaPicco and @Sarah_Haines_ .. lets see if I can pull out a few key findings 1/
2/ First up @PPrathivadi talking about GPs use of PDMP, benefits for informing prescribing but challenges with reluctance to use technology - also check out this super commentary with @Sarah_Haines_ in the @AusJPrimHealth on evaluation considerations
publish.csiro.au/py/PY20296
publish.csiro.au/py/PY20296
3/ Next is @LouisaPicco talking about implementation of prescription monitoring with #pharmacists. Alerts seem to really drive responses (over other clinical risk factors).. are automatic alerts replacing clinical judgement? Conclusion: PDMP should not replace clinical decisions
1/ @AmerMedicalAssn applauds
decision by @HHSGov to allow physicians to prescribe #buprenorphine without an X-waiver for the treatment of patients with #opioid use disorder. #OUD
However, it is important to keep in mind several considerations: ama-assn.org/press-center/a…
decision by @HHSGov to allow physicians to prescribe #buprenorphine without an X-waiver for the treatment of patients with #opioid use disorder. #OUD
However, it is important to keep in mind several considerations: ama-assn.org/press-center/a…
2/ •Use of #buprenorphine by a person who has #OUD but is not in withdrawal can precipitate withdrawal. This is a significant adverse experience. It also dissuades patients from adherence to treatment.
3/ •It is unclear whether removal of the X-waiver requirement for #buprenorphine-prescribing will increase access to care in the community. Already, physicians who have an X-waiver do not see the full allowed complement of patients who have #OUD.
Happy Holidays! I'm starting a #FOAMed gift exchange.
My gift to #MedTwitter is-
🎁5 reasons to continue your patient's #buprenorphine perioperatively!🎁
My gift to #MedTwitter is-
🎁5 reasons to continue your patient's #buprenorphine perioperatively!🎁
1) Turns out bup is a great analgesic, and is actually unlikely to have a ceiling dose for analgesia. Abruptly stopping someone's basal analgesic + inflicting painful stimulus = poor postop pain control!
pubmed.ncbi.nlm.nih.gov/29624528/
pubmed.ncbi.nlm.nih.gov/16547090/
pubmed.ncbi.nlm.nih.gov/20492579/
pubmed.ncbi.nlm.nih.gov/29624528/
pubmed.ncbi.nlm.nih.gov/16547090/
pubmed.ncbi.nlm.nih.gov/20492579/
2) Furthermore, bup's unique receptor profile affords a ceiling dose for resp depression, likely adding safety in the high-risk postop period. Changing to only pure mu agonists instead likely ⬆️risk for AEs
pubmed.ncbi.nlm.nih.gov/29452378/
pubmed.ncbi.nlm.nih.gov/16547090/
pubmed.ncbi.nlm.nih.gov/20492579/
pubmed.ncbi.nlm.nih.gov/29452378/
pubmed.ncbi.nlm.nih.gov/16547090/
pubmed.ncbi.nlm.nih.gov/20492579/
Thanks @UTMBFamilyMed for inviting me to present Grand Rounds today! I'm going to share a few pearls for other interested folks in #FamilyMedicine, #TwitteRx, & beyond.
A long but extremely visual🧵🧵🧵
A long but extremely visual🧵🧵🧵
To understand the "opioid crisis", you have to accept that the first wave was driven by excessive prescribing. BUT you also have to accept that reactionary supply reduction interventions drove a totally preventable second wave of deaths due to heroin.
In order to help the people who are actually dying today, you must recognize that deaths to Rx opioids accounted for fewer than ⅓ of all opioid overdose deaths, and that proportion is shrinking every year.
Advice from the DHHS about maintaining continuity for pharmacotherapy treatment is here. Key principals include writing prescriptions for longer (with regular phone check-ins with patients) and increased TA doses where clinically appropriate (1/3)
bit.ly/3e4EpSu
bit.ly/3e4EpSu
Guidance to support assessing appropriateness for additional takeaways are here. Where clinically appropriate, increasing takeaways means that people can stay safe at home and travel pharmacies. #Naloxone is recommended with takeaways bit.ly/2UQgmiy (2/3)
Documents to support dose delivery are here bit.ly/2RilpGe (3/3) Much credit to the dedicated staff at @VicGovDHHS @VAADAENEWS and the broader sector in developing these resources for those providing #methadone and #buprenorphine @psa_vic @HRV_Aust @RACGP @DrGrinzi
Wrote this piece with the help of a great team including @DrKevinHill. Below I'll share some of my thoughts about #opioids and opioid use disorder and how they present in #hpm and #palliative care, plus why we need to do a better job of addressing #addiction at end of life. 1/x
2/x Training in #KY gave me a front row seat to the #opioidcrisis. With an interest in #hpm I kept wondering what would happen to these individuals who developed an OUD and years later were prescribed opioids. How would I keep those patients safe and manage their pain?
3/x I continue to think that our field will struggle in years to come when survivors of the #opioidcrisis age, develop serious illness, and develop pain. Thinking about this, and reading @jeff_deeney article in @TheAtlantic theatlantic.com/health/archive… made me want to do more.
