Thread by @StefanKertesz

1/A recent #opioid prescription report on @npr emphasized geographic variations in prescribing. Although no one account will suffice, the question of why these variations exist is quite approachable. A few paths are offered npr.org/2020/07/17/887…

2/One view is that communities vary in health practices because of unjustifiable variations in excess treatment - it's the legacy of work by Dartmouth investigators, popularized by @Atul_Gawande in a 2009 article on McCallen Texas newyorker.com/magazine/2009/…

3/That view lost a degree of traction in part due to concerns about whether the Dartmouth team's "last 2 years of life" approach fully adjusted for differences between patients. thehealthcareblog.com/blog/2016/09/2…

4/With pain care, lack of access to health professionals (orange & blue in the lower map) overlaps a bit with high #opioid prescribing (orange/red in the upper map). Fewer care resources may mean more #opioids. Walker County, Alabama is highlighted.

5/You can drill down and ask if perhaps economic distress also relates to greater prescribing of #opioids. There's a hint of that below. I'm far from the first to point this out.

6/Let's note that geographic overlap between written #opioid prescriptions and actual overdose with potential Rx opioids is weak (see Northeast!). That's because "Rx opioid" OD's usually involve other substances. jamanetwork.com/journals/jaman…

7/Please note this is just a "window in" and not an "answer to" the questions on #opioid variations. Geographic, racial and economic disparities in care matter to many of us who care about equitable access to health and to health care. #COVID19 has made that even more obvious.

@tal7291 @AjayManhapra @ADAWnews @lipiroy @liebschutz @honoraenglander @UnhealthyAlcDrg @maiasz @AJ_Gordon @choo_ek