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 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
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
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
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
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. ncbi.nlm.nih.gov/pmc/articles/P…
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.gov/drugoverdose/p…
#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) 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
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.
jamanetwork.com/journals/jama/…
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.

acpjournals.org/doi/full/10.73…
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 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
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 academic.oup.com/painmedicine/a…
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.” painphysicianjournal.com/current/pdf?ar…
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 ncbi.nlm.nih.gov/pmc/articles/P…
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 harpers.org/archive/2018/0…
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. jamanetwork.com/journals/jaman…
@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. bmj.com/content/368/bm…
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.

#necropolitics
#USAeconomicmurder
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.

#suicide
#USAeconomicmurder
Read 13 tweets

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