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1/I am sort of gratified to see @CMSGov confirm what we have been saying from VA data: that dose based criteria are quite poor at identifying prescription recipients at risk for opioid related harms jamanetwork.com/journals/jama/…
2/CMS tested if #opioid dose > 90 + high # of prescribers/pharmacists could detect people at high risk and it did, sort of weakly, with 2.5% sensitivity, by 2014, given a criterion of later Gerri f a new opioid use disorder diagnosis or an overdose 
3/CMS concluded correctly that dose and pharmacy thresholds are not really good at identifying and this not good at helping to mitigate most opioid related harms - and that blunt honesty is what I appreciate about @CMSGov : not much spin!
4/@AJ_Gordon &I laid this out in @AddictionJrnl (see image). That + analysis of our US policies is now free & open access. Rx dose is one risk factor among many, but it is not terribly helpful if your goal is to find people at most risk and protect them onlinelibrary.wiley.com/doi/full/10.11…
5/ data from V.A. & Kaiser show again and again, yes the Rx matters (don’t treat dose escalation with anything other than caution) but h/t @AjayManhapra it is the person behind the pill who requires attention
6/Intermittebtly someone will ask if my goal is to recapitulate discredited big Pharma logic that asserts that all risk is “the person” & prescribing has no role, etc. Lest someone ask again, that is daffy. The issue is avoid pill myopia in our policy response. That is all.
