Discover and read the best of Twitter Threads about #cpp

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This is the Dec, 2015 IPRCC meeting that talks about HHS’ plan and the CDC guidelines. Starting at 4hrs, 18 min, we have Wanda Jones, principal deputy to asst. sec of HHS speak about how HHS planned the guidelines. This is really interesting info.
1/?
videocast.nih.gov/watch=17523
At 4 hrs 41 min, the CDC rep presents the overview of the guidelines. At 4:52 sec., the Q and A’s. This really shows how there were a lot of concerns from the research panel (NPS) about the consequences and methods/bias involved in the formation of the CDC GLs.
#ipp #cpp #PROP
At 5 hrs 24 min we have the evidence that shows the IPRCC (NPS) was not happy about the CDC guidelines and had a discussion about how to handle that. Listen carefully. videocast.nih.gov/watch=17523
Read 8 tweets
I explore @andrewkolodny claims

Evidence based quotes, tweets, articles, & professional affiliations

I demonstrate his medically unfounded & logically unsound

Major points numbered

Blog to follow

A thread 1/
KOLODNY AGENDA

Supported by Kolodny Claims (KC)

KC #1 NO non-bupe/suboxone opioids for anyone
PROP affiliation, letter
LINK bmj.com/content/372/bm…

KC #2 Bupe for all SUD CPP long term opioid "consumers"
Current CDC recommendations
LINK
cdc.gov/drugoverdose/p…
2/
K= Kolodny rhetoric applied
a= my claims & general content my analysis of K

KC #3 (KC 3)- CPPs think opioids treat their underlying conditions & that's why CPPs want #opioids
Since opioids don't treat underlying conditions must deny #CPPs opioids
LINK
google.com/amp/s/abcnews.…
3/
Read 28 tweets
PROP dismisses experience as anecdotal, yet consistently fails to offer logically sufficient reasons as to why my experience w/ acute short term opioid effectiveness valid & my experience w/effective #opioid pain management 13-22 yrs later as a #CPP is not
bmj.com/content/372/bm…
1- Kolodny definition of physiological dependence/tolerance used to invalidate #opioid effectiveness for #CPPs is False
For his Lie to hold true, #opioids would cease to have effect re to #SUD too, as addicts & CPP share long term opioid use experience & similar tolerance process
#Opioids have effect on body directly re to opioid
Why/how could they not?
Kolodny tries to have us believe his delusion
He perverts tolerance by falsely equating physiological dependence w/underlying physiological health condition to try to deny opioid efficacy CPP long term use
Read 5 tweets
How's long term #ChronicPain patient opioid effectiveness reporting different than that of one who takes opioids short term?
I'm BOTH
3 wks intravaneous dilaudid post surgery in hospital
NOTHING FOR 13 YRS
NOW #CPP
What makes CPP experience anecdotal invalid discounted dismissed?
Kolodny perverts natural wearing off of opioid ALL feel "feeling pain again after no pain" to mean "more pain/supersensitivity" & "physiological dependence" re to #CPP long term opioid use makes #opioids ineffective (?) discounting effects of opioids re decades long opiate #SUD!
THERE'S NO TRUTH TO PROP CLAIMS
Recent PROP letter displays radiant ignorance of current fentanyl OD deaths- MUST DISCOUNT!
ALL EVIDENCE CONTRARY TO THEIR ANECDOTAL "OPINION PIECE."
PROP: CROCK OF SHIT EVIL ADDICT
KILLING SADISTS
It's time to IGNORE!
#CPP
bmj.com/content/372/bm…
Read 4 tweets
#cpp The National Pain Strategy is a complete disaster. It’s so transparent, when you spend your life on the sidelines you observe a lot-like gaslighting by policy in service to the War on Drugs. The U.S. NIH has known since the 1970s that opiate pain medicines are safe,
miraculously helpful for most people in pain, and addiction is rare with use. This same society that doesn’t want to have to see bodies with painful illness created the conditions of poverty and despair that led people prone to addiction to start using drugs irresponsibly.
NPS was a plan to make us fit into a tidy box that looks just how the morally, physically, financially superior want everything around them to look. Chronically ill, disabled people frequently in need of medicine to mitigate pain just..."don't look hygenic” if you live in a
Read 11 tweets
I find it wildly inappropriate that #AndrewKolodny is promoting opioid free breast surgery by elevating a #pacira pharma-paid MD! Talk about a sexist hypocrite. See for yourselves! #ipp #cpp #PROP #PainProfiteers
openpaymentsdata.cms.gov/physician/3044…
Just an FYI- Pacira - maker of #Exparel, a patented post op buvicane injectable that’s being advertised as the answer to the opioid crisis. The corruption, smh.
Read 6 tweets
Here is the #PedsICU #BestOf2020 collection.
Jointly chosen by @Dr_Hari_Krishna @sgdambrauskas @miguelrrMD
Pubmed collection 40 articles: bit.ly/pedsicubestof2…
Infographic (clickable PDF) in English: bit.ly/bestof2020eng
Spanish: bit.ly/bestof2020esp
#PedsCICU #NeuroPICU
The #Bestof2020 #PedsICU pubmed collection will also be available in the FREE #PICCHub app (sponsored by @PICSociety) as the latest monthly #PICUJournalwatch collection:
Download links: Android: play.google.com/store/apps/det…
iOS: apps.apple.com/gb/app/picchub…
.@sgdambrauskas and @MiguelrrMD will be simultaneously sharing their thoughts about the #PedsICU #Bestof2020 collection in a tweetorial.
Read 40 tweets
@ravensspirit68 @funchefchick @NitaGhei @StefanKertesz @AllysonVarley @PainPtFightBack @LelenaPeacock @tal7291 @urbanfatbiker I'm working on a big annotated bibliography of #cpp/rx #opioid research that I'll put online for activists to use. Here are studies I've got on #CPP-associated #suicide. Send me titles & authors for papers I'm missing & I'll add them. I'll link them below.
Tang et al 2006 review: Risk of death by #suicide at least doubled in #ChronicPain patients. Ideation is 3 times more common; lifetime prevalence of about 20%. 8 risks for suicidality in chronic pain were identified, half are physical.
researchgate.net/profile/Cather…
Tang et al: 8 risks for #suicide in #ChronicPain patients: 4 are physical, including type, intensity & duration of pain & sleep-onset insomnia co-occuring with #pain; 4 are psychological. CP is a neurological suicide risk AND a psychological risk.
Read 15 tweets
For each #Province and #Territory in #Canada, here is the help that was offered to those living with #disabilities. This will include the #Federal help offered as well as any hoops #PWDs may have needed to jump through to get it and whether CERB was clawed back or not.
This is based on my own research, and if anyone sees anything I missed or may have gotten wrong please let me know.
Let's start with #Yukon
According to several articles, eligible families on #disability supports we're to get up to $400 to help with costs until August. Unknown what eligibility was.
#CERB was exempt from clawbacks.
Read 19 tweets
Risk of OD to prescribed #opioids is 0.13% (Kaiser, Jnl of Pain 2019), while risk of death by OD increases more than 300% with dose variability of ≥30% (JAMA 2019).

VHA study: discontinuation increases the risk of death by #OD or #suicide up to 6.8 times (BMJ 2020). / thread
0.13% = risk of OD to prescribed #opioids (Kaiser 2019). Dose reduction is "inconsistent" in lowering OD risk. Research found "no support for RSM [risk stratification & monitoring] as a means of decreasing overdose.”

Jnl of Pain 2019;20(1) jpain.org/article/S1526-…
0.1% to 0.23% = risk of OD to prescribed #opioids, per Canada's 2017 Guideline.

0.1% for <20 MED, 0.14% for 20–49, 0.18% for 50–99 MED, 0.23% for ≥100 MED.

Discontinuation carries a significantly higher risk of death.
#PCP #MedicalTwitter
ncbi.nlm.nih.gov/pmc/articles/P…
Read 10 tweets
There is a very simple way to prove that #CPP & #IPP are NOT addicted to our #OpioidRxs. All that needs to be done is to cure our pain. When our pain is cured no one will need to taper us. We would do our own record breaking taper because we are not addicted to our Rx’s.
When our pain is gone we much prefer a drug free life, and we are absolutely not addicted to our pain. Will you accept this challenge Dr Kolodny? Cure our pain if you are that skillful as a doctor then just watch us run from drugs. Try saving us instead of killing us. Until then
Until then, until you can cure our pain the humane and ethical way to treat pain patients is to restore as much of our #QOL as possible which will allow us to have a near normal life while we wait for doctors to find a cure for our pain. #IPP
Read 3 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
#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
Today, I'm seeing a lot of #chronicpain/#intractablepain community members going in on politics, thinking that politicians care one way or the other. Here's the truth about that. Warning: don't read if you don't want to know. #thread
1) Melania recently gave an anti-opioid speech. Here is the link:

ntd.com/melania-trump-…
2) Donald Trump's White House has been notoriously anti-opiod for the past four years.

whitehouse.gov/opioids/
Read 10 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
A #Podcast to catch for those in #chronicpain. #CPP
My daughters hope is one day that she can remove #opioids from the medications she takes. Honestly I don’t know if that’s a reality but her one concern is tapering. I want #physicians knowledgeable in this. 1//
We have seen the absolute devastation of #physicians pulling when effective, when an ind has benefitted & enjoying a QoL. Also we have seen #physicians abandon #patients and ‘cold turkey’. I do NOT support removal of opioids when they are benefitting an ind but for 2/
I do want a safe and effective process if a person feels they want to do this. 3/
Read 3 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
Doctors tell people helped by rx #opioids they "don't work." @StefanKertesz: there's "only a modest % in whom to look for evidence of benefit" because 25-60% stop the meds because of non-addictive side effects & av 3.3% (per CDC) stop because of abuse/addiction. 1/3
“Forced tapers, slow or fast, can harm previously stable patients, while crossing ethical lines doctors normally respect. Advocates for this approach have stepped ahead of data, when available science dictates a more tempered approach" (@AjayManhapra, @StefanKertesz 2018). 2/3
⭐️ Short, well-written paper about the evidence for & ethics of #opioid tapers. #CPP #ChronicPain #migraine 3/3

Kertesz SG, Manhapra A. The drive to taper opioids: mind the evidence, and the ethics. Spinal Cord Series and Cases. 2018 Jul 27;4(1):1-4. ncbi.nlm.nih.gov/pmc/articles/P…
Read 3 tweets
2019 study in the AMA journal reports that reducing access to rx #opioids has "failed" to reduce overdoses.

OD crisis is projected to become "substantially worse" if public policy continues to wrongly target medical use. (thread) filtermag.org/rate-of-opioid…
Chen et al (JAMA 2019): Analyses of programs designed to reduce overdoses by reducing the medical use of #opioids "have failed to demonstrate a consistent benefit on fatal or nonfatal opioid overdoses." jamanetwork.com/journals/jaman… Image
JAMA> #OD rates are projected to soar 149% above 2015's crisis levels by 2025. Overdose deaths from 2016-25 could reach as high as 1.21 million if the crisis doesn't soon stabilize.

🟡 Continuing prescription restrictions will have a "modest effect, at best" on reducing ODs. Image
Read 13 tweets
Yearly since 2012, #opioid prescriptions have hit all-time lows as #overdoses hit all-time highs. Here's why:

1>#Addiction thru medical use is "very rare" (@AmericanCancer Society).

2>Multiple studies show stopping/tapering rx #opioids *increases* the risk of OD or #suicide. Image
#CDC had to get #squirrely w/ data in 2013 to make it seem as tho #opioid scripts were fueling overdoses. Note they compare kilograms per 10,000 to ODs per 100,000 & literally fail to connect the dots when scripts fell in 2012. Image
#Opioid prescribing peaked 8 years ago, & drug overdoses are the #1 cause of death for Americans under 50. Denying or discontinuing medicine *increased* rates of #OD & #suicide.

Doctors & policymakers are killing people to "save" them from the "very rare" risk of #addiction.
Read 6 tweets
2012 column by leading pain expert B Eliot Cole, MD, MPA, warned that "radical changes" proposed by a group calling itself #PROP would deny #opioids "to the majority of patients now receiving them for noncancer pain." / thread hcplive.com/view/just-how-…
In the early 2000s, "buoyed by the success of treating cancer-related pain with #opioids, many physicians rose to the challenge of doing more for their patients suffering with #ChronicPain," Cole wrote.
"This led to an increase in the number of prescriptions for #opioids, which had the unintended consequence of more opioids ending up in medicine cabinets in more homes, ultimately giving more people (🚩not patients) access to these valuable medications for nonmedical purposes."
Read 21 tweets

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