Discover and read the best of Twitter Threads about #opioids

Most recents (24)

.@headsUPmigraine spoke w/ a rural #PCP hounded out of the profession by relentless pressure to stop rxing #opioids. She was the only PCP in +100 miles willing to accept patients on opioid therapy. Most were over 70. 2018 #AMA statement shows many share her frustration. >thread
In 2018, #AMA passed a resolution against “misapplication” of the CDC Guideline by “pharmacists, health insurers, pharmacy benefit managers, legislatures, & governmental & private regulatory bodies in ways that prevent or limit patients’ medical access to #opioid analgesia.” 2/
#AMA: "physicians should not be subject to professional discipline, loss of board certification, loss of clinical privileges, criminal prosecution, civil liability, or other penalties or practice limitations solely for prescribing #opioids" above CDC's recommended dose. 3/
Read 13 tweets
I am angry tweeting and usually that is never good but I am angry. My heart is breaking for another mother who lost their child to pain. She had her entire life in front of her. Her entire life! For many years she struggled with #pancreatitis. She was 1/
not in an area where there were many #physicians aware of #pancreatitis. I provided the mother names of experts in the field but sadly they never followed up or called. I have often seen this. As a parent I would carry around my husband & kids genetic 🧬 results 2/
in order to ensue that physicians would listen to me. I’d provide them with the names or our specialists. A few times physicians listened many times they did not. So often my husband was questioned about his alcohol use relentlessly EVEN with the test results. It was a 3/
Read 16 tweets
.@NBCJoshua Illegal, not medical, #opioid use fuels ODs, which have risen exponentially since at least 1979, predating more liberal prescribing patterns. Addiction & use aren't rising: people are taking increasingly lethal drugs & combinations of drugs. /thread Image
.@TheWeekMSNBC "Overprescription" isn't "fueling the OD crisis." @AmericanCancer says #addiction in medical use is "very rare." #CDC Guideline is based on an average 96% unremarkable use; 4% includes nonaddictive misuse & long use. Large studies put addiction rate under 1%. 2/
Canada's Guideline: 96.7% unremarkable use; 3.3% includes nonaddictive misuse & abuse, in keeping w/ #CDC's Guideline. Brat et al. found a 99.4% rate of unremarkable use in more than 1 million post-op opioid scripts. 0.6% included people who refilled their scripts (BMJ 2018). 3/
Read 15 tweets
Thank you to @BethDarnall for speaking at #Minnesota @MinnesotaDHS #Opioid Work Group mtg on Thursday: Spoke of importance of #patientcenteredcare, #patientconsent necessary if taper & strongly advised AGAINST force tapers & using pre-determined MME'S. #ChronicPain #NoOneSize
MN #opioid Work Group created Taper Guidance. It will be out 4 public comment soon. Some areas extremely problematic. Although it states NOT 2 taper solely 2 meet system or state policy; MN Quality Improvement requires Drs 2 meet MME thresholds = TAPER TO MEET STATE POLICY. 🤔
If #ChronicPain pt wants 2 try 2 taper from #opioid analgesics 4 any reason & CONSENTS, there needs 2 be safe way 2 do it. Problem throughout U.S, incl #Minnesota; is non-consensual tapering. Many experts, incl #addiction specialists, stress dangers & even state it's UNETHICAL.
Read 11 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)…
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…
Read 10 tweets
@louisanamom In 2016, CDC said there wasn't good evidence showing reductions in rx #opioids would reduce ODs. Of their study of 221 #vets (who, sadly, have higher rates of OD/suicide), they said, "caution should be taken in drawing causal inferences from this observational study.” 1/
@louisanamom I don't know why CDC's 2016 paper is titled "a detailed exploration into the association of prescribed #opioid dosage & OD deaths" when it admits there were 2 low-quality studies + their "don't assume anything about cause & effect" study!…
@louisanamom In 2016, @CDCgov had NO SOLID EVIDENCE about whether rx #opioid reductions & discontinuation would help or hurt. Here's their review of evidence (table 1). Read the column "Limitations."

By 2017, they knew it didn't reduce ODs. 1/…
Read 8 tweets
Drug Seeker Part III
So after almost 8 years of undertreated/untreated pain, this year I was officially labeled a drug seeker by certified mail & banned from care by a medical clinic in our town for requesting a benzodiazepine medication that was helping to mediate severe spacial disparity & vertigo.
Vertigo is now another battle that started after a Shingles & a #MyalgicEncephalomyelitis flare. I was also beginning diagnostics to determine if I have breast cancer as well. Getting that letter was humiliating-Devastating as I live in a rural town with limited options for care.
Read 15 tweets
@DrTomFrieden With all due respect, Dr. Frieden, why didn't you follow science when you directed @CDCgov & you learned in 2018 that fatal overdoses went up, not down, following implementation of the 2016 #Opioid Guideline you promoted?…
@DrTomFrieden @CDCgov #CDC-funded research in 2018: “declines in these opioid prescribing metrics ... have not been followed by decreases in opioid overdoses. Instead, overdoses due to illegal opioids ... have increased.” Why didn't CDC retract the Guideline when it saw deaths were going UP?
@DrTomFrieden @CDCgov In 2016, #CDC Director Frieden told the press that the risks of rx #opioids would outweigh benefits for "vast majority of patients.” But the Guideline itself said an average 96% of patients had no addiction or non-addictive abuse, misuse, or long use.…
Read 15 tweets
One of our local Universities received a grant to implement #OneRx. I find the actions that they encourage highly alarming & stigmatizing. 1) approach patient to discuss only partial fill on #opioid medication 2) provide naloxone (ok with this), 3) refer to MAT 1/ Image
My kids see a team of physicians who know their medical issues. Their issues are complex. I am not sure what I would do if a #pharmacist approached the kids to engage in discussion of only partially filling meds or referring to #MAT. It’s as though there is no understanding 2/
that most on #opioids have seriously tried other modalities of treatment. What will it take to have a balanced narrative instead of one completely #stigmatizing & #shaming 3/
Read 4 tweets
I’ve known a lot of folks in recovery who have returned to use during quarantine. Some after years of abstinence recovery.

It is a positive to normalize that people can return to use even after 16 years of abstinence.

So, a few things on @daxshepard.


He said he has an rx and also is purchasing pills.

•Most folks don’t have access to a safe supply, particularly with opioids.

•Purchasing pills for most people runs the risk of receiving pressed pills, adulterated with fentanyl, analogs, or other synthetics.

Opioid stories and recovery stories seem to always be focused on white stories.

Circle back to tweet 1, I think it is important to acknowledge using after 16 years of abstinence being a reality.

But this isn’t the exact reality of many PWUD and people with SUD.

Read 8 tweets
Time to highlight another article I link to often.

“Whitewashed: The African American Opioid Epidemic”
by @ChiUrbanLeague

Quote thread 🧵


#racism #overdosecrisis #opioids
“...portrayed as a problem affecting young whites in suburban and rural areas. In Illinois, the Midwest, and indeed much of the United States, this is a wholly inaccurate depiction. The prevailing narrative neglects how people of color have been profoundly impacted”

“•African Americans are dying from opioid overdose at a rate higher than the general population in several states, including Illinois, Wisconsin, Missouri, Minnesota, and West Virginia, and in Washington, D.C.;”

Read 14 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…
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
#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…
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…
"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
Read 8 tweets
Still struggling with the wording of this invitation. ‘#COVID-19 has exacerbated the raging #opioid crisis driven by the nation’s more than 50 million #pain suffers......’. I have contacted both @RepJudyChu & @RepWalorski office to express my concern & to 1/ Image
attempt to understand why the blame for the #opioidepidemic seemed to be placed at the feet of those that have #chronicpain. In the past years the # of #opioid pain medication prescriptions have plummeted yet rates of overdose climbed. Many individuals with #chronicpain 2/
who benefitted from treatment from #opioids have been pulled off & abandoned; their #QoL decreasing & suffering increasing. My kids & my husband were/are part of the 50 million that experience/experienced #chronic pain due to #hereditarypancreatitis & #pancreascancer 3/
Read 5 tweets
Here is a preview/summary of my talk today at the @NIH conference on 'Social Determinants of Opioid Use: Establishing a Research Agenda'…
1. Our problem is bigger than #opioids. Its bigger than drugs altogether. An over focus on specific drugs risks that we’ll impose #policies that target specific substances rather than the #underlyingcauses of use.
2. We regularly hear that #addiction is a #braindisease. But its more than that. Addiction is a social disease.
Read 13 tweets
#Pain impacts all areas of ones lives. It’s difficult to address. The current climate around those with #chronicpain is full of stigma & biases. The narrative that #opioids are bad & do not assist those w #pain or that there are a plethora of non-opioid 1/
continues to impact those that have #chronicpain negatively. IF you have #chronicpain you are acutely aware that care for those in #pain is poor in the USA. There may be ‘pockets’ where one can access superb care but I believe it is few & far between. We did NOT need the #CDC 2/
guidelines. They were Honecker by an ‘expert’ group whose sole focus was on #SUD NOT the treatment of pain. I believe they took the guidelines and encouraged the misapplication of these guidelines. Instead work should have been done to focus on better treatment options 4 those 3/
Read 11 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
This makes me so furious. I don’t know what has to be said to make individuals aware that #opioid #pain meds benefit many. I don’t ever condone violence, ever, yet try to put yourself in inds shoes who have benefitted from #opioids & their QoL has improved. Many of these 1/
Individuals have had medications ripped away due to #CDC, #PROP, the misapplication of #CDC guidelines, anti opioid advocates (that advocate for OTHER opioids). Let’s have a balanced approach. Peoples lives have been harmed. Not just theirs but their families 2/
This is #PainAwarenessMonth & it’s been a struggle seeing so many who do not and will not understand the experience of many with #chronicpain. For those throwing around ‘there are many non opioid options’ no, there are not & most of the time those on opioids have already tried 3/
Read 4 tweets
With all the talk RE: #OpioidCrisis I didn't think I could feel lower than I do now but boy was I wrong! Cont:...
Drove through my pharmacy today & I asked my pharmacist about my insurance calling & I asked him his opinion.. honestly I am shocked. He said that #opioids are bad for people's health and do kill patients even responsible patients. Cont:...
I wanted to know how many cpp's have lost their meds & he said insurance co are going after every patient on LTOT & even though I am a "lucky patient" his words, that I will end being taken off all meds. Cont:...
Read 10 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
🔴 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.…
.@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

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