Thread by @JillPiggott

@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? ncbi.nlm.nih.gov/pmc/articles/P…

@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.
cdc.gov/media/releases…

@DrTomFrieden @CDCgov Table 1 in the 2016 #CDC Guideline itemized the “limited number” & “notable limitations” of the “low quality” studies w/ “methodological shortcomings” upon which they based recommendations that continue to cause incalculable suffering and end lives.

@DrTomFrieden @CDCgov NO studies were included in the 2016 #CDC Guideline that evaluated the benefit of #opioids for chronic #pain. See CDC's admission that their evidence was "low quality" in Table 1 following the references.
cdc.gov/mmwr/volumes/6…

@DrTomFrieden @CDCgov Researchers tasked with developing Canada's #opioid guideline wrote, “The limitations of the CDC guideline include largely restricting involvement to experts who have been critical of opioid use for chronic noncancer pain, limited involvement of patients..." 1/

@DrTomFrieden @CDCgov "... excessive restrictions on selection of evidence (e.g., insisting on studies with a follow-up of 1 year or more excluded more than 100 randomized controlled trials (RCTs) of treatment w/ #opioids in shorter durations) ..." 2/

@DrTomFrieden @CDCgov "... suboptimal application of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) rating system to address evidence quality; excessive use of strong recommendations in the face of low-quality evidence; and vagueness in some recommendations.” 3/

@DrTomFrieden @CDCgov Anticipated harms of adopting the #CDC Guideline “could include withdrawal reactions, uncontrolled #pain, anxiety for patients and loss of trust in their physicians.” 4/

@DrTomFrieden @CDCgov Evidence from British Columbia, where the #CDC Guideline was adopted as a standard of practice, found patients sought illicit opioids to cope with uncontrolled pain following taper. Given the “profusion of counterfeit fentanyl,” the “consequences could be fatal.” 5/

@DrTomFrieden @CDCgov #Canada's critique of the #CDC #Opioid Guideline:

Busse JW, Juurlink D, Guyatt GH. Addressing the limitations of the CDC guideline for prescribing opioids for chronic noncancer pain. CMAJ. 2016 Dec 6;188(17-18):1210-1. ncbi.nlm.nih.gov/pmc/articles/P…

@DrTomFrieden @CDCgov In 2019, @CDCgov said dosage caps & sudden discontinuation “conflict with the Guideline’s emphasis on individualized assessment of the benefits and risks of #opioids given the specific circumstances and unique needs of each patient.”
cdc.gov/media/releases…

@DrTomFrieden @CDCgov #CDC needs to do more than blame healthcare providers & legislators for "misapplication" of the rx #opioid Guideline. Thousands are dying. THOUSANDS. A VA study tracked #vets whose rx was stopped in FY 2013 & found 2,887 had died from #overdose or #suicide.

@DrTomFrieden @CDCgov Oliva, Bowe, Manhapra, @StefanKertesz, Hah, Henderson, Robinson, Paik, Sandbrink, Gordon, Trafton. Associations between stopping prescriptions for #opioids, length of opioid treatment, and #overdose or #suicide deaths in US veterans. BMJ. 2020 Mar 4;368. bmj.com/content/368/bm…