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Intern'l group of #pain experts called for urgent action on forced #opioid tapering in March 2019.

In early 2019, FDA warned that rapid & sudden tapers are harmful & can kill. They issued guidance to help doctors protect patients from harm. /thread academic.oup.com/painmedicine/a…
Rapid/forced tapering can destabilize patients, "precipitating severe #opioid withdrawal accompanied by worsening #pain & profound loss of function. To escape the resultant suffering, some patients may seek relief from illicit (and inherently more dangerous) sources of opioids."
"New & grave risks now exist because of forced #opioid tapering," including an "alarming rise" in suffering & #suicides in civilians & #vets. Even patients at doses below 90 MME are being forced to taper.
"Currently, no data exist to support forced, community-based #opioid tapering to drastically low levels w/o exposing patients to potentially life-threatening harms."

Experts called for an urgent review of mandated opioid tapering in prescribing, pharmacy, & insurance policies.
.@US_FDA issued new warnings about forced discontinuation & sudden or rapid tapers in April 2019. fda.gov/drugs/drug-saf…
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Jill Piggott
@JillPiggott
2017 Review: “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.” / #cpp thread.
🟠 How can guidelines be "expert" recommendations if researchers haven't carefully investigated how patients will react when their rx #opiod med is stopped or reduced?

Are we going to feel better or worse? Are we going to live or die?
In 2017, #VA-funded researchers identified 67 studies about #opioid dosage reduction or discontinuation.

Study quality was deemed “poor” in 76% of the 67, the lowest rating.
Read 21 tweets
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Jill Piggott
@JillPiggott
“Contrary to scientific evidence of efficacy and negative recommendations, a significant proportion of physicians and patients (92%) believe that #opioids reduce pain" & 57% "report better quality of life": 2017 Guideline from American Society of Interventional #Pain Physicians.
Amer'n Society of Interventional Pain Physicians' 90-pg guide focuses on ways to "reduce the abuse & diversion of #opioids w/o jeopardizing access for those patients suffering from non-cancer pain who have an appropriate medical indication for opioid use.” painphysicianjournal.com/current/pdf?ar…
Latin American Pain Federation's 2019 position paper on #opioid & #pain management: "Although scientific evidence supports the safe use of opioids, there is still significant reluctance around the use of these analgesics." #cpp ncbi.nlm.nih.gov/pmc/articles/P…
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Jill Piggott
@JillPiggott
What have false assumptions about rx #opioids cost people in #pain? Damn near everything.

@Brian_Goldstone's report ought to be required reading for every #PCP & every legislator who wants to play doctor. #MedicalTwitter harpers.org/archive/2018/0…
For 4 yrs, an rx #opioid let Austin Sell escape the cage of pain, care for his kids, study to become a physician asst to help others w/ #ChronicPain. Then lawmakers in DC imposed a limit on what his clinic could prescribe. "And that was it. The app'ment lasted about 10 minutes."
Dr @StefanKertesz told @Harpers: “In a time of incredible tragedy, there’s a desire for something simple to latch onto as a way of explaining it. A story that has a clear-cut villain, with doctors as dupes and patients as innocent victims, is about as easy to sell as any story.”
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