Thread by @JillPiggott

2019 study in the AMA journal reports that reducing access to rx #opioids has "failed" to reduce overdoses.

OD crisis is projected to become "substantially worse" if public policy continues to wrongly target medical use. (thread) filtermag.org/rate-of-opioid…

Chen et al (JAMA 2019): Analyses of programs designed to reduce overdoses by reducing the medical use of #opioids "have failed to demonstrate a consistent benefit on fatal or nonfatal opioid overdoses." jamanetwork.com/journals/jaman…

JAMA> #OD rates are projected to soar 149% above 2015's crisis levels by 2025. Overdose deaths from 2016-25 could reach as high as 1.21 million if the crisis doesn't soon stabilize.

🟡 Continuing prescription restrictions will have a "modest effect, at best" on reducing ODs.

Reducing #opioid scripts fails to reduce ODs for 2 reasons:

1>Addiction in medical use is very rare. CDC 2016 put safe use at an average 97%. The 3% includes non-addictive misuse, abuse, "long use," & addiction.

2>Multiple studies (many VA-funded) show deaths go UP when #opioids are discontinued.

Thousands are dead because their doctors dropped or stopped their meds to protect them from a 0.1 to 0.23% risk of overdose thru medical use (< 20 mg to ≥ 100 mg MME). (Links below)

2,887 #vets whose #opioid medicine was stopped in FY 2013 died of #overdose or #suicide (90 fewer than died on 9/11).

2020 VA study found people were up to 6.8 times more likely to die from OD or suicide if their meds were stopped than if they continued. bmj.com/content/368/bm…

2019 #PrimaryCare study: Risk of fatal #overdose was nearly tripled (2.94) when #opioids were stopped vs. continued. 4.9% of discontinued patients died of OD, while 1.75% of retained patients did so. Provider-initiated stops are more deadly & more common.
link.springer.com/article/10.100…

2017 VA study found #vets whose #opioid med was stopped had 2.4 times the rate of ideation & 6 times the rate of self-harm when compared to other vets. Authors explain why it's “likely” they underestimated these rates. suicideinfo.ca/wp-content/upl…

Glanz, et al., JAMA 2019: #Opioid dose variability triples the risk of death by overdose.

Tapering meant to reduce OD risk & "adhere to prescribing guidelines" in fact increases the risk of fatal overdose 3-fold. jamanetwork.com/journals/jaman…

Glanz et al: 1 reason "substantial reductions" in #opioid rx's haven't resulted in "significant decreases" in ODs is that dose variability itself triples the risk of fatal ODs.

Study calls this an "unintended consequence."

🔴 It's time to say the policy is killing people.

Overdose is “very uncommon” in people prescribed less than 50 MME & “uncommon” in those taking 50–90 MME, acc'g to Canadian 2017 #Opioid Guidelines.

MME/day OD rates: 0.1% for <20 MME; 0.14% for 20–49 MME, 0.18% for 50–99 MME, 0.23% for ≥ 100 MME.

ncbi.nlm.nih.gov/pmc/articles/P…

headsUPmigraine is patient-led & #footnote-assisted advocacy. I direct hUm with my colleague Dr @NitaGhei.

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Fitzgerald wasn't thinking about patient-led advocacy when he finished "The Great Gatsby," but I'm filching the line anyway. @hope411adcock @PROPkills @amylorrainelong @JSG_54 @StopBadDocs

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