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Andrew Kolodny @andrewkolodny
, 12 tweets, 3 min read Read on Twitter
1) Using the WaPo rating system, I think this STAT op-ed deserves Three Pinocchios:… via @statnews
2) Three Pincocchios means: Significant factual error and/or obvious contradictions. This gets into the realm of “mostly false.” But it could include statements which are technically correct but are so taken out of context as to be very misleading.
3) Many false and misleading statements. For example, article states “in more than half of U.S. states, patients in acute pain from surgery or an injury may not by law fill an opioid prescription for more than three to seven days, regardless of severity of their surgery or injury
4) The statement is false. Only four states (ME, NC, NJ, NY) apply duration limits (5-7 days) regardless of severity. Other states with short duration limits allow professional judgement exceptions and surgical exceptions.
5) Here’s another false statement: “Opioid prescribing is currently at an 18-year low.” Not true. Prescribing has been trending down for the past few years, but we are nowhere near 2000 levels & we still consume far more opioids per capita than any other country on earth.
6. Here’s a misleading statement: “rate of prescribing opioids has dropped every year since 2011. Yet drug overdose deaths have skyrocketed since then.” OD deaths in HEROIN users skyrocketed because of FENTANYL but in many states, Rx deaths declined.
7. Here’s another doozy- “CDC places the risk of addiction with the long-term use of opioids at 0.07-6 percent.” Not true. CDC cited a claims data study with that range. But for prevalence of opioid addiction in primary care, CDC gave range of 3-26%.
8. Misleading: “In other surveys, physicians said that they were prescribing fewer opioids or ceasing treatment of pain patients altogether because of regulatory scrutiny." In the cited survey, many more docs listed “improved understanding of opioid risks” as the main reason.
9. All nitpicking aside, most dishonest is the implication that long-term opioids are more likely to help than harm patients with chronic pain. An abundance of evidence suggests otherwise.
10. Over the past 23 years, millions of patients with pain have become opioid addicted and thousands have died from opioid overdoses. Compassionate treatment for chronic pain is NOT jeopardized by more cautious opioid prescribing - it demands it.
11. Prescribing started trending in a more cautious direction in 2012, about 4 years before CDC Guideline. The fear and anger of opioid dependent pain patients is understandable. We need programs and policies to help these victims of our era of aggressive prescribing.
12. We can do better to address the needs of these patients by relying on science & facts instead of anecdote. The multi-faceted industry-funded campaign that got us into this mess relied on anecdote and misinformation. Let’s not repeat history.
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