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Jonathan Giftos, MD @JonGiftosMD
, 3 tweets, 2 min read Read on Twitter
@OlioDevin Very much appreciate your thoughts. A few questions/comments.

1. Are you saying term PWUD suggests all people who use drugs need treatment? Definitely not my intent here. More to say that PWUD are exposed to some risk & deserve safe space to talk about that. All deserve “care.”
@OlioDevin 2. Re: gold standard — didn’t mean to comment on gold standard of psychological care. Not my expertise. The example here was OUD & gold standard is OAT +/- psychosocial services & recovery support if patient interested. Nature of psychosocial services certainly varies by person.
@OlioDevin 3. Lastly: love your emphasis on human connection. Would very much agree that should be part of gold standard for all our interventions.
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Jail: the churn vs. the grind (THREAD)

For past 2.5 years I have worked as a physician caring for patients in NYC jail, and as an advocate for humane drug policy. In light of #CloseRikers and efforts to transform jail-system, I wanted to share brief thread on jail dynamics. 1/
First, I want to remind people there is fundamental difference between jails & prisons. Jails city/county based & largely hold people detained pre-trial (many held in on bail). Most people do not know when they are leaving & unplanned release the norm. Key words: flux, chaos. 2/
In NYC in 2017, there were 37,000 people admitted to jail on new charge (not including technical violations of parole) w/ average 7,100 people held pre-trial in jail on any given day. Many leave within a week, but others stay for months to years. Key words again: flux, chaos. 3/
Read 10 tweets
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This was a complex story to tell. And I appreciate @richschapiro overall thoughtfulness, and for including my quotes of caution around the lessons we take from Ms. Rivera’s journey through the justice system. A few extra thoughts. #Thread nydailynews.com/new-york/ny-me…
In early 2017, reporting by NYDN made public the location of a gathering space for PWID known as “The Hole” in South BX. In a reflexive & short-sighted response, NYC bulldozed site w/o replacing it with safer alternative such as a SIF/SCS for people not ready/able to stop using.
This razing destabilized a community of PWID — a community that cared for one another, despite struggles — and many were pushed into shadows. According to friends close to story, many died as result of using in more isolated spaces like abandoned buildings even further from care.
Read 6 tweets
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Stigma, revealed.

A clinician approaches me to say that he disagrees w/ our effort to offer patients w/ opioid use disorder methadone or bupe maintenance while incarcerated. Better, he says, for us to “detox” as many patients as possible so they are “normal” when they leave. 1/
I shared some data, citing increased mortality risk for patients w/ OUD during post-release period & evidence suggesting these medications associated w/ large reduction in that risk. He responds by saying, “Well, I just don’t want to pay for it ... you know, as a tax payer.” 2/
So, I then share what we know from Massachusetts Medicaid data, that patients on maintenance medications tend to cost society less per month than do patients not on medications (fewer ODs, ER visits, HIV infections, etc). He listens, then follows up with the kicker ... 3/
Read 6 tweets

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Here is General Mattis' resignation letter, as published in WaPo this evening. #FridayFeeling
washingtonpost.com/politics/2018/…
2-"Defense Secretary Jim Mattis is resigning, effective in February. And, like former secretary of state Rex Tillerson, he’s not exactly making his concerns about President Trump a big secret. In his resignation letter, Mattis strongly suggests he doesn’t have much faith in
3-"Trump’s vision or leadership. And it’s not even all that veiled. [Here is] the letter, with annotations [in parenthesis]:
Dear Mr. President: I have been privileged to serve as our country's 26th Secretary of Defense which has allowed me to serve alongside our men and women of
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Homeland Security and Defense Department Officials Joint Press Conference on the Defense Department Deployment to the Southwest Border

@drawandstrike @catesduane @rising_serpent @_ImperatorRex_ @Debradelai @GodlessNZ @almostjingo @tracybeanz @TheChiIIum

dod.defense.gov/News/Transcrip…
Kevin McAleenan, U.S. Customs and Border Protection Commissioner; Air Force Gen. Terrence J. O'Shaughnessy, commander of North American Aerospace Defense Command and U.S. Northern Command
STAFF: Appreciate everybody attending today's press conference. The purpose of today's press briefing is to provide an update on Operation Secure Line and the Department of Defense deployment at the southwest border.
Read 109 tweets
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Here at “Addressing Fentanyl- #harmreduction strategies to reduce overdose” featuring @DanCiccarone @jondocsin and Jon Zibbell w Maya Doe Simmons as moderator.
Ciccarone’s talking about the triple wave epidemic, starting with prescription opioids, then shifting to heroin, and this third wave with synthetics and fentanyl. #HarmRed18
The fentanyl problem is regional particularly on the east coast. His study was conducted in Baltimore MD, Lowell & Lawrence MA, Chicago IL, and WV. Their interviews and data collection was trying to treat it like a new drug, exploratory. #HarmRed18
Read 36 tweets
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At @OSULawDEPC for the @DrugPolicyOrg @acluohio conference From Punishment to Public Health. I am going to tweet a lot about drug policy in the next two days. I know many people want to focus right now on the critical moment the nation is going through, feel free to mute me.
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Read 177 tweets
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I'd like to take some time to talk about harm reduction and disease prevention, specifically pertaining to drug use and sex. Party on (safely)!
Let's set some ground rules. I am not going to respond to rude or derogatory remarks or questions about people who use drugs or people who engage in sex work or other sexual behaviors. Actually, that's pretty much my only rule.
I'll be using some acronyms to make things easier, like PWUD and PWID: people who use drugs and people who inject drugs. I also do my best to avoid using the term "addict." Additionally, none of what I say reflects my employer or should be construed as medical advice.
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Here's the latest #qanon post in 13 tasty bites.
#MAGA #WWG1WGA
I think the big reveal is coming.
Once people don't believe what they are told anymore - the power is gone. People keep waking up to the fact they've been lied to and played for a very long time.
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