@BrianMannADK I was stunned to see your @NPR piece on rx #opioids. I direct @headsUPmigraine & have been writing a paper reviewing research on rx restrictions. Limits haven't just failed to reduce ODs, they've contributed to an INCREASE in ODs, suicide, disability. 
AMA Jnl 2019: Efforts to curb ODs "have principally focused on restricting the supply" of rx #opioids. They've "failed to demonstrate a consistent benefit on fatal or nonfatal opioid overdoses." Continuing them "may have a modest effect, at best," on ever-rising illegal-drug ODs.
Since peak in 2012, scripts are down 35% but overdoses are up 250%. That's because #addiction in medical use is "very rare," as @AmericanCancer Society explains. Even #CDC 2016 put unremarkable use at 97%, w/ 3% incl'g non-addictive "long use" & physical dependence.
From the Journal of Pain Research (2019): "The standard explanation of the overdose crisis"--the explanation you & @NPR offered again today--"is wrong, and the policies it has inspired are not only ineffective, but harmful."
Oliva, @StefanKertesz, et al. Associations between stopping prescriptions for opioids, length of opioid treatment, and overdose or suicide deaths in US veterans: observational evaluation. BMJ. 2020 Mar 4;368. bmj.com/content/368/bm…
Fink et al. 2019: 3 studies found “statistically significant” rises in heroin ODs following Prescribing Drug Monitoring Program.
Fink, Schleimer, et al. Association between PDMP & ODs. Annals of Internal Medicine. 2018 Jun 5;168(11):783-90.
ncbi.nlm.nih.gov/pmc/articles/P…
Fink, Schleimer, et al. Association between PDMP & ODs. Annals of Internal Medicine. 2018 Jun 5;168(11):783-90.
ncbi.nlm.nih.gov/pmc/articles/P…
Discontinuation of rx #opioids in #PrimaryCare was associated w/ 3 times the risk of OD. Patients whose providers initiated discontinuation were at increased risk, and providers had initiated discontinuation in at least 77% of cases. James et al 2019.
James, Scott, Klein et al. Mortality after discontinuation of primary care–based chronic opioid therapy for pain: a retrospective cohort study. Journal of General Internal Medicine. 2019 Dec 1;34(12):2749-55. link.springer.com/article/10.100…
Patients on stable #opioid dosages were 3.3 times LESS likely to OD. 2019 study recommends "minimizing dose variability when managing long-term opioid therapy,” exactly the opposite of what many states, practices, hospitals, and insurers now recommend or mandate. Glanz et al.
Glanz JM, Binswanger IA, Shetterly SM, Narwaney KJ, Xu S. Association Between Opioid Dose Variability and Opioid Overdose Among Adults Prescribed Long-term Opioid Therapy. JAMA Network Open. 2019;2(4):e192613. jamanetwork.com/journals/jaman…
A VA-funded systematic review of all research in English about #opioid dosage reduction or discontinuation found “very low” evidence of benefits to patients. Study quality was deemed “poor” in 76% of the 67, the lowest rating (Frank 2017).
Overall evidence was very low for all 6 outcomes: pain severity, pain-related function, quality of life, #opioid withdrawal symptoms, substance use, or adverse events. There's "very-low-quality evidence that opioid dose reduction may improve pain, function, and quality of life."
Frank JW, Lovejoy, Becker, Morasco, et al. 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…
In 2019 FDA responded to widespread reports of patient harm from rapid & involuntary #opioid tapers. In VT, hundreds of Medicaid recipients were forced off well-established opioid scripts above 120 MME with no taper. Half were stopped cold; 86% were tapered in under 3 weeks,
Half had an adverse event: 91% were seen in ERs, 9% were hospitalized (Mark 2019). @StefanKertesz (2019) notes the study “could only capture the 1st harm detectable in a payer database." No one tracks whether patients like VT's Medicaid recipients die after being forced off med.
Mark TL, Parish W. Opioid medication discontinuation and risk of adverse opioid-related health care events. Journal of Substance Abuse Treatment. 2019 Aug 1;103:58-63. sciencedirect.com/science/articl…
I highly recommend: @StefanKertesz, Outcomes after opioid discontinuation: It’s time to stop counting. Journal of Substance Abuse Treatment. 2019 Aug 1. uab.edu/medicine/dopm/…
Perez et al. found people tapered down or off rx #opioids were up to 6.4 times more likely to receive NO medical care from ANY provider the year following taper or discontinuation compared w/ those still treated. Only 9.2% had complete discontinuation, which is now common.
Perez HR, Buonora M, Cunningham CO, Heo M, Starrels JL. Opioid taper is associated with subsequent termination of care: A retrospective cohort study. Journal of general internal medicine. 2020 Jan 1;35(1):36-42. link.springer.com/article/10.100…
Perez: opioid tapers are associated w/ "poor patient outcomes." Husain: #PrimaryCare patients are 3x times more likely to terminate care following #opioid tapers. Opioids ensure people disabled by #ChronicPain can continue to get medical, dental, psychological, & spiritual care.
Husain JM, LaRochelle M, Keosaian J, Xuan Z, Lasser KE, Liebschutz JM. Reasons for opioid discontinuation and unintended consequences following opioid discontinuation within the TOPCARE trial. Pain Medicine. 2019 Jul 1;20(7):1330-7.
ncbi.nlm.nih.gov/pmc/articles/P…
ncbi.nlm.nih.gov/pmc/articles/P…
Termination of care & patient abandonment are common as doctors adopt practice-wide #opioid bans. AMA Journal found 40.7% of Michigan #PrimaryCare providers refuse to accept new patients receiving opioid therapy for pain, regardless of type of insurance (Lagisetty).
Lagisetty PA, Healy N, Garpestad C, Jannausch M, Tipirneni R, Bohnert AS. Access to primary care clinics for patients with chronic pain receiving opioids. JAMA Network Open. 2019 Jul 3;2(7):e196928-.
jamanetwork.com/journals/jaman…
jamanetwork.com/journals/jaman…
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