Thread by @JillPiggott

Systematic review of research on dose reduction & discontinuation concluded, "Very low quality evidence suggests ... pain, function, and quality of life may improve w/ #opioid dose reduction."

People are dying & being disabled on the basis of "very low quality evidence."

2017 study: “Expert guidelines recommend reducing or discontinuing long-term #opioid therapy when risks outweigh benefits, but EVIDENCE on the effect of dose reduction on patient outcomes has NOT been systematically reviewed."

How "expert" can it be?

The VA funded a team who reviewed all research in English about #opioid reduction-discontinuation. 67 studies were identified, but the study quality was deemed “poor” in 76% of the 67, the lowest rating.
acpjournals.org/doi/full/10.73…

The “overall quality of the evidence was VERY LOW for all 6 prespecified patient outcomes”: pain severity, pain-related function, quality of life, opioid withdrawal symptoms, substance use, or adverse events."

Gov't-funded researchers found very low evidence for a gov't policy.

2020 study: #Vets whose medication was discontinued after 3 months overdosed or killed themselves at nearly 4 times the rate of those who continued to be treated. Those whose medicine was stopped after more than 1 year overdosed or killed themselves at 6.8 times the rate (Oliva).

One more time: Discontinuing #opioid medicines increased the risk of fatal overdoses by 4 to 6.8 times.

You know how they know that? PEOPLE DIED. A LOT of people died. When is #enough enough? Who's going to be the last person to die for this mistake?

Frank JW, Lovejoy, Becker, Morasco, Koenig, Hoffecker, Dischinger, Dobscha, Krebs. Patient outcomes in dose reduction or discontinuation of long-term opioid therapy: a systematic review. Annals of internal medicine. 2017 Aug 1;167(3):181-91. acpjournals.org/doi/full/10.73…

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

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