Thread by @speakingabtpain

The misapplication of the CDC guidance as strict laws and enforceable mandates is indiscriminate and is harming pain patients - the report questions this - opioids are also essential medications.

https://twitter.com/NatlAssnAttysGn/status/1112720124019204101

If you need some evidence - see the recent letter sent by three former drug czars and medical experts, covered in the @nytimes and @rollingstone and elsewhere

Or the international stakeholder letter by experts w/ radically different views on opioid prescribing for pain, as covered internationally in @Reuters_Health and other outlets on three continents docs.google.com/document/d/1Rz…

Or the @hrw report summarized here latimes.com/opinion/op-ed/…

Or another piece nytimes.com/2019/02/09/opi… or statnews.com/2018/12/06/ove… (which covers the reasons the @AmerMedicalAssn came out against misapplication of the guideline)

Given the prescribing has dropped precipitously - and is at a 15 year low according to @US_FDA in terms of prescriptions filled in pharmacies and has dropped almost 75% according to the @CDCgov since 2015

& that overdoses are driven largely by illegal fentanyl, heroin and increasingly stimulants like cocaine and methamphetamies and that virtually all (90%) deaths are from multiple substances used in combination (illicit and licit, often including alcohol)

It might be time in 2019 to reconsider balancing the interests of legitimate uses of the medication with our concerns for misuse.

It's likely impossible given that dosages given by the CDC to apply to new, opioid naive patients are now the basis for surveillance in state AG's offices and USA offices alike -

But it is perfectly appropriate and laudable for a Pain Task Force at @HHSGov to re-evaluate the @CDCgov guidelines and -- especially -- their misinterpretation and misapplication.