Discover and read the best of Twitter Threads about #vets

Most recents (24)

.@speakerbowers @GaSecofState @GabrielSterling I want to thank you all for what you did to protect the Constitution and our vote. As I like to tell Trump and his following, they are the RINOs, what you see are real Republicans standing up for the Constitution. >
Real Republicans stand up for things that Trump does not. The 6th should have shown them that. A President trying to overthrow the Constitution and did do and has done everything he could to "cancel" our votes. >2
A President that sends his hordes to the Capitol to kill anyone he was against... like Mike Pence... to destroy our REAL electors' votes. A President that was happy that the police were getting beat the sh*t out of them by "his people." A President that condemned our> 3
Read 21 tweets
1/3 I had a lot of time to do thinking while in this fleabag motel. As I thought I recalled a speech I think it was Harris but do not hold me to that. It was said that the OAS pension would run out by 2021. If anyone can find that on Youtube or newspaper I would appreciate.
2/3As I have not hidden this tweeter who is disabled and 51 yrs old believes #seniors #disabled #vets and anyone who relies on the govt, are being culled. Does it not seem strange that this vaccine MAY be ready by the END 2021. We have the biggest population of #seniors right now
3/3 Baby boomers are aging and are Seniors. So since the OAS is running out. And #disabled are being completely ignored during this WORSE time during the pandemic. Yet they say there are discretionary funds for the #disabled but TRUST THIS TWEETER there is nothing. #ODSPoverty
Read 8 tweets
2,887 #vets died of #overdose or #suicide after they were taken off #opioids meds by the VA to adhere to guidelines. @StefanKertesz & colleagues found stopping meds increases the risk of death up to 6.8x (study in linked tweet). @headsUPmigraine thanks him for his work.
2,887 #vets died of #OD/suicide after their rx #opioid was stopped in FY2013, only 90 fewer deaths than on 9/11.
Stopping treatment was associated with increased risk of fatal OD/#suicide regardless of the length of treatment (Oliva et al BMJ 2020). 1/3
#Vets whose #opioid med was stopped were 1.67 to 6.77 times more likely to die than those who continued to be treated. Deaths were highest in 1st 3 months after treatment was stopped. 2/3

Oliva, Bowe, Manhapra, Kertesz et al. BMJ 2020.…
Read 4 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.…
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
.@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
.@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
.@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
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
@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
@carmenxbrook #MedicareForAll Act of 2019: Introduced in the House 2/27/19.

House members who support the bill: 118. Number of additional House members needed for passage: 100.…
@carmenxbrook #MedicareForAll Act of 2019: Introduced by #Bernie 4/10/19.

Senators who support the bill: 15. Number of additional Senators needed for passage: 45 w/ filibuster, 36 w/o filibuster.…
@carmenxbrook IF #Republicans hold the Senate, NO #healthcare bills will pass. McConnell & the GOP are killing 400 bills, most bipartisan, passed by the House incl'g multiple bills on rx drug prices, #vets' healthcare, preexisting conditions. See the list here:…
Read 13 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
🔴 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
Now we know Trump mocked a man's #disability because he feels "disgust for those who have suffered." As president, he told staff "not to include wounded #veterans" in an event because “Nobody wants to see that."

Trump's views of #vets: reporting from @TheAtlantic (thread)
.@FoxNews @AP & other media organizations have verified @TheAtlantic's reporting that Trump lied when he said he couldn't reach a French cemetery to honor America's war dead. In fact, "he feared his hair would become disheveled in the rain."
“Why should I go to that cemetery? It’s filled with losers," Trump told senior staff members," referring to America's WWI fallen. During the same 2018 trip, he referred to the "more than 1,800 marines who lost their lives at Belleau Wood as 'suckers' for getting killed."
Read 22 tweets
How anyone who respects #vets wouldn't crawl thru mud to #VoteBiden is beyond me.

After reading Trump's shameful comments, I Googled the name of the #POW whose name I wore on my wrist for years. What I learned couldn't stand in starker contrast to @realDonaldTrump.
#POW Cpt Lynn Guenther was shot down & spent 14 months in the infamous Hanoi Hilton. He said the experience taught him "the real meaning of tolerance and love - tolerance for those around us and love for the country and world we live in" (link below).…
.@realDonaldTrump You didn't avoid #Vietnam b/c you were a Conscientious Objector. You cooked up a #bonespur because you're a coward & have no commitment to serving others. Here's the #POW whose name I wore on my wrist during the War.…
Read 16 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
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
2,887 #vets died of overdose or suicide after their rx #opioid was stopped by the VA in FY 2013. That's just 90 fewer bodies than total US deaths on 9/11. Efforts to stem the crisis of ODs to illegal drugs by restricting rx access have failed b/c medical use isn't the cause. 1/3 Image
2019 study projects 1.21 million will die in US 2015-25 of #opioid ODs AND it explains that rx restrictions aren't just failing to help: they're making the problem worse.

It's obscene.

People w/ #ChronicPain AND w/ #addiction are suffering under a policy that's KILLING us. 2/3
.@headsUPmigraine fights for evidence-based rx #opioid policies that treat people w/ #addiction & #ChronicPain individually, effectively & non-fucking-fatally.

We're looking for partners who advocate for people w/ addiction &/or for #vets (#veterans).…
Read 3 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
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
Stefan coauthored a 2020 VA study that tracked #vets whose #opioid was stopped in FY 2013 & found 2,887 had died of suicide or OD. 1 year of a VA policy produced 90 fewer bodies than terrorists did on 9/11. OD/suicide tripled in PCP patients whose med was stopped. Link below.
James JR, Scott JM, et al. Mortality after discontinuation of primary care–based chronic opioid therapy for pain: a retrospective cohort study. Journal of General Internal Medicine. 2019 Dec 1;34(12):2749-55.…
Oliva, Bowe, Manhapra, Kertesz, Hah, Henderson, Robinson, Paik, Sandbrink, Gordon, Trafton. Associations between stopping prescriptions for opioids, length of treatment, & OD or suicide deaths in US veterans: observational evaluation. BMJ. 2020 Mar 4;368.…
Read 3 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

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