Discover and read the best of Twitter Threads about #opioid

Most recents (24)

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…
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.…
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…
🔴 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
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.…
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
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?…
#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😉… Image
Read 12 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…
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
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…
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.”…
2016 VA study didn't find evidence to support the claim that increases in med'l #opioid use lead to increases in intentional OD.…
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…
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…
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
Patient deaths & harm led #CDC to clarify in 2019 that people on long-term stable #opioid doses above 90 MME should be tapered "only if the risks [of continuing the medicine] seem to outweigh the benefits." Yet hard dosage caps continue as policy & law. /thread
In 2019, CDC, FDA, HHS, & medical experts also urged doctors to seek patient consent before tapering #opioids.

Forced tapers violate the cardinal rule "Do no harm," as forced & mandatory tapers put people at significantly higher risk of harm, distress, disability, & death.
🟠 #CDC recommends tapers of 10% per wk to 10% per month, noting the latter is better for people on long-term #opioids.

2019 JAMA study of +100k people found 1 in 5 were tapered faster than 40% per month & 5% faster than 60% per month.…
Read 9 tweets
Those least likely to develop #addiction are most likely to get an #opioid rx: 1/2 of the 15% of Americans who filled an opioid rx in 2018 were 55+ with 1/4 of all rx's going to people over 65.

2016 study found a 0.3% #addiction rate. The risk of addiction drops .68% per decade. Image
#CDC: Prevalence of substance use disorders involving schedule II #opioids (age 12+ US 2018): 0.6%.

Schedule II drugs can be rx'ed. Most abuse involves illegal drugs. CDC relies on self-reported data for its annual report.…
#CDC 2019: "Rates of #opioid rx's continued to drop, continuing the trend that began in 2012."

But: "The rate of drug overdose deaths increased significantly from 1999 to 2017."

That's because medical use does not fuel the epidemic of overdoses to illegally-obtained drugs.
Read 6 tweets
1/Out today in @JAMANetworkOpen, our @NIDAnews funded project aimed to look at real world barriers for pregnant women with #opioid use disorder accessing treatment.

We found barriers, but not just for pregnant women. Image
2/We used >10,000 secret shoppers in 10 states. Standardized actors trying to get into treatment. They called, using @samhsagov public lists for waivered buprenorphine providers & opioid treatment programs.

Random selection of providers. Random selection of pregnancy/insurance. Image
3/Main finding - pregnant women with #opioid use disorder have a harder time than women of reproductive age getting into treatment, & this varies widely by state.

Pregnancy itself is a barrier. Image
Read 9 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)…
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."… 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
In 2019, #CDC Guideline authors quoted their 2016 stats:

"nearly 2 million" have #opioid use disorder,
"estimated 3% to 4%" rely on long-term opioid therapy
"approximately 11%" report daily #pain

"Nearly 2 million"=nearly 0.6%. Stick with me.…
Before governments recommend & legislators, providers, & insurers adopt policies that could harm up to 11% to possibly protect 0.6%, they need damned good evidence that what they're recommending is necessary.

But they didn't know if rx #opioid limits would help or kill.
#CDC set off a tidal wave of limits in 2016, even tho the studies then available on dose limits provided "very-low-quality evidence" that reducing or stopping med would improve pain, function, or quality of life. 76% got the *lowest* rating for evidence.…
Read 10 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…
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
2017 Review: “Expert guidelines recommend reducing or discontinuing long-term #opioid therapy when risks outweigh benefits, but evidence on the effect of dose reduction on patient outcomes has not been systematically reviewed.” / #cpp thread.
🟠 How can guidelines be "expert" recommendations if researchers haven't carefully investigated how patients will react when their rx #opiod med is stopped or reduced?

Are we going to feel better or worse? Are we going to live or die?
In 2017, #VA-funded researchers identified 67 studies about #opioid dosage reduction or discontinuation.

Study quality was deemed “poor” in 76% of the 67, the lowest rating.
Read 21 tweets
Intern'l group of #pain experts called for urgent action on forced #opioid tapering in March 2019.

In early 2019, FDA warned that rapid & sudden tapers are harmful & can kill. They issued guidance to help doctors protect patients from harm. /thread…
Rapid/forced tapering can destabilize patients, "precipitating severe #opioid withdrawal accompanied by worsening #pain & profound loss of function. To escape the resultant suffering, some patients may seek relief from illicit (and inherently more dangerous) sources of opioids."
"New & grave risks now exist because of forced #opioid tapering," including an "alarming rise" in suffering & #suicides in civilians & #vets. Even patients at doses below 90 MME are being forced to taper.
Read 6 tweets
“Contrary to scientific evidence of efficacy and negative recommendations, a significant proportion of physicians and patients (92%) believe that #opioids reduce pain" & 57% "report better quality of life": 2017 Guideline from American Society of Interventional #Pain Physicians.
Amer'n Society of Interventional Pain Physicians' 90-pg guide focuses on ways to "reduce the abuse & diversion of #opioids w/o jeopardizing access for those patients suffering from non-cancer pain who have an appropriate medical indication for opioid use.”…
Latin American Pain Federation's 2019 position paper on #opioid & #pain management: "Although scientific evidence supports the safe use of opioids, there is still significant reluctance around the use of these analgesics." #cpp…
Read 5 tweets
What have false assumptions about rx #opioids cost people in #pain? Damn near everything.

@Brian_Goldstone's report ought to be required reading for every #PCP & every legislator who wants to play doctor. #MedicalTwitter…
For 4 yrs, an rx #opioid let Austin Sell escape the cage of pain, care for his kids, study to become a physician asst to help others w/ #ChronicPain. Then lawmakers in DC imposed a limit on what his clinic could prescribe. "And that was it. The app'ment lasted about 10 minutes."
Dr @StefanKertesz told @Harpers: “In a time of incredible tragedy, there’s a desire for something simple to latch onto as a way of explaining it. A story that has a clear-cut villain, with doctors as dupes and patients as innocent victims, is about as easy to sell as any story.”
Read 25 tweets
@NitaGhei @amylorrainelong @BrianMannADK @NPR @headsUPmigraine @vicwj @carriefeibel @MPBN @SusanSharon1 Exactly. I used to say rx #opioid limits didn't help people w/ addiction & harmed people w/ #pain until I started reading research & saw they're harming EVERYONE. Dose variability itself triples the risk of OD.…
@NitaGhei @amylorrainelong @BrianMannADK @NPR @headsUPmigraine @vicwj @carriefeibel @MPBN @SusanSharon1 “Attempts to discontinue #opioid therapy to reduce the risk of overdose & adhere to prescribing guidelines may lead patients to be exposed to variability in opioid dosing. Such dose variability may increase the risk of opioid overdose” by greater than 3-fold. Glanz, JAMA 2019
@NitaGhei @amylorrainelong @BrianMannADK @NPR @headsUPmigraine @vicwj @carriefeibel @MPBN @SusanSharon1 If people are being pushed off rx #opioids to save their lives, it needs to stop NOW because the practice is KILLING PEOPLE. OD/suicide rates go up A LOT: 3 times (Glanz JAMA 2019), 4-6.8 times (Oliva/Kertesz BMJ 2020). ...
Read 8 tweets
.@NPR's response to the outcry that they wrongly blamed medical #opioid use as the cause of the OD epidemic? 4 days later they did it again. @BrianMannADK @carriefeibel @vicwj This is LAZY & HARMFUL reporting.

Evidence shows: #ODs & #suicides go UP as # of scripts goes DOWN.
.@NPR @BrianMannADK @carriefeibel @vicwj

🔴 2,887 #vets DIED from #OD or #suicide AFTER their #opioid pain med was stopped in FY 2013.

🔴 1 year of the VA's policy to take #vets off medicine produced just 90 fewer bodies than 9/11. (Link next tweet)
VA study showing people are 4 to 6.8 times MORE LIKELY to die of #overdose or #suicide after discontinuation of a prescription #opioid. THIS IS NOT AN OUTLIER. @NPR, PLEASE contact co-author @StefanKertesz.…
Read 9 tweets
1. The American necropolitical system and the death of a thousand cuts.

I am halfway through writing a book on #suicide and training focused on understanding suicide.

2. The medicalized version of #suicide, according to which suicide is a manifestation of mental illness and, therefore, tautologically, suicides are predominantly caused by mental illness is logically and empirically false and I am providing evidence for my argument.
3. The current increase in self-destructive deaths which include deaths that don't end up as suicides in public statistics is a result of the intensification of American #necropolitics.

Read 13 tweets

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