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).
14.2% of patients who were "clinically stable" before their #opioid med was stopped died after discontinuation, primarily of #suicide.
None showed evidence of depression or suicidality while treated. Average age of patients was 46 (Salerian 2015).
The effort to protect people in #pain from a 0.1% risk of fatal overdose is killing Americans by the thousands.
Who will be the last to die for this mistake?
#MedicalTwitter #cpp #ChronicPain #migraine @CDCgov
SOURCES: Kaiser Permanente Washington: Von Korff M, Saunders K, Dublin S, et al. Impact of chronic opioid therapy risk reduction initiatives on opioid overdose. Journal of Pain. 2019;20(1):108-117.
jpain.org/article/S1526-…
Oliva EM, Bowe T, @AjayManhapra, @StefanKertesz, Hah JM, Henderson P, Robinson A, Paik M, Sandbrink F, Gordon AJ, Trafton JA. Associations bwn stopping rx's for opioids, length of treatment, & overdose or suicide deaths in US veterans: BMJ. 2020 Mar 4;368. bmj.com/content/368/bm…
James JR, Scott JM, Klein JW, Jackson S, McKinney C, Novack M, Chew L, Merrill JO. Mortality after discontinuation of primary care–based chronic opioid therapy for pain. Journal of General Internal Medicine. 2019 Dec 1;34(12):2749-55. link.springer.com/article/10.100…
Salerian AJ. Discontinuation of Opiate Treatment: A Retrospective Review Of 49 Patients. J Psychol Clin Psychiatry. 2015;2(4):00083. researchgate.net/profile/Alen_S…
@headsUPmigraine @NitaGhei @hope411adcock Check out this: Kaiser study: 0.1% = rate of fatal OD in medical use. They had the numbers, but didn't calculate the 0.1%. Wonder why? Also: risk stratification doesn't reduce ODs & dose reduction is "inconsistent." 1/2
All interventions failed to decrease 0.1% rate of OD. So they said 1>Let's INCREASE the dose reductions! 2>I kid you not pg 7, column 1: the problem isn't our "expert recommendations," it's the "busy" #PrimaryCare doctors' fault. 3>We'd be right if the sample were larger. #tb
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