Jill Piggott Profile picture
Sep 16, 2020 12 tweets 8 min read Read on X
0.1% = rate of fatal #OD in the medical use of #opioids acc'g to 2019 research from Kaiser Permanente (link below).

Bwn 2006-2014, 41 of 31,142 died of OD, a rate of 5 per year. Risk stratification did not lower OD rates. Dose reductions were "inconsistent" (VonKorff). /thread
2,887 #vets died by #overdose or #suicide after their #opioid medicine was stopped by the VHA in FY2013 (90 fewer than on 9/11) (Oliva et al 2020).

Patients whose rx opioid was stopped were 3 times MORE likely to die by OD than those whose medicine continued (James 2019).
4.9% of discontinued patients died of OD.
1.7% of continued patients died of OD.

Discontinuation of rx #opioids was associated with 1.35 times the risk of death & 2.94 times the risk of fatal OD compared to patients whose rx continued (James et al 2019).
14.2% of patients who were "clinically stable" before their #opioid med was stopped died after discontinuation, primarily of #suicide.

None showed evidence of depression or suicidality while treated. Average age of patients was 46 (Salerian 2015).
The effort to protect people in #pain from a 0.1% risk of fatal overdose is killing Americans by the thousands.

Who will be the last to die for this mistake?

#MedicalTwitter #cpp #ChronicPain #migraine @CDCgov
SOURCES: Kaiser Permanente Washington: Von Korff M, Saunders K, Dublin S, et al. Impact of chronic opioid therapy risk reduction initiatives on opioid overdose. Journal of Pain. 2019;20(1):108-117.
jpain.org/article/S1526-…
Oliva EM, Bowe T, @AjayManhapra, @StefanKertesz, Hah JM, Henderson P, Robinson A, Paik M, Sandbrink F, Gordon AJ, Trafton JA. Associations bwn stopping rx's for opioids, length of treatment, & overdose or suicide deaths in US veterans: BMJ. 2020 Mar 4;368. bmj.com/content/368/bm…
James JR, Scott JM, Klein JW, Jackson S, McKinney C, Novack M, Chew L, Merrill JO. Mortality after discontinuation of primary care–based chronic opioid therapy for pain. Journal of General Internal Medicine. 2019 Dec 1;34(12):2749-55. link.springer.com/article/10.100…
Salerian AJ. Discontinuation of Opiate Treatment: A Retrospective Review Of 49 Patients. J Psychol Clin Psychiatry. 2015;2(4):00083. researchgate.net/profile/Alen_S…
@headsUPmigraine @NitaGhei @hope411adcock Check out this: Kaiser study: 0.1% = rate of fatal OD in medical use. They had the numbers, but didn't calculate the 0.1%. Wonder why? Also: risk stratification doesn't reduce ODs & dose reduction is "inconsistent." 1/2
All interventions failed to decrease 0.1% rate of OD. So they said 1>Let's INCREASE the dose reductions! 2>I kid you not pg 7, column 1: the problem isn't our "expert recommendations," it's the "busy" #PrimaryCare doctors' fault. 3>We'd be right if the sample were larger. #tb
@headsUPmigraine (Hi mother. You started this. You taught me to #read. @janpurcell2)

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More from @JillPiggott

Nov 25, 2020
#Migraine is a neurological disorder, not a terrible, disabling #headache," expert @DavidDodick explains. #Pain is "just 1 clinical manifestation deriving from a sensory processing disturbance affecting the nervous system" (Morgan, Lancet 2020). /Thread thelancet.com/journals/laneu…
Billie lost her insurance when #migraine disabled her: “There are days I don't see anything except for shapes." Visual warnings are the most commonly recognized auras, but these symptoms are highly variable, both in different patients & on different days for the same patient. 2/
Difficulty speaking or speaking clearly is another common #migraine symptom, either preceding or during an attack.

Poor St. Husband. He watched this clip & said, "Yup, that's you." I spent a lotta years in school to talk like this. 3/
Read 7 tweets
Nov 25, 2020
A Yale study of 10 patients found 1 dose of #psilocybin can cut #migraine frequency in half for 2 weeks. Each patient did 1 session with placebo, 1 with the drug. People who felt most high got the least migraine relief. /thread newatlas.com/health-wellbei…
The Yale researchers who conducted the small, but 1st of its kind study suggest #migraine patients might benefit from microdoses or sub-hallucinogenic doses of #psilocybin. Understanding how psilocybin prevents migraine might open new pathways for drug development, as well.
I did 2 #migraine clinical trials. I'm glad someone else took this one for the team. I hated Methysergide (Sansert), now discontinued, which was synthesized from lysergic #acid. A 1965 study said Sansert users experienced a "confused feeling of unreality." Tell me about it.
Read 7 tweets
Nov 24, 2020
“[W]idespread & variable dysfunction of the nervous system…comprises the aberrant brain state of a #migraine attack” (Charles 2017).

Daily/near-daily migraine is continuous migraine. Imaging shows our brains *always* look like brains during an "attack" (Brennan 2018). >thread
Recurrent #migraine & #pain aren't benign. “Long-lasting &/or repetitive pain over years leads to profound functional as well as structural changes in the brain networks" (Brennan).

Ineffective treatment is a leading risk of progression to continuous migraine. #MedicalTwitter
Brennan & Pietrobon's paper "A Systems Neuroscience Approach to #Migraine" (Neuron 2018) is @headsUPmigraine's favorite. I excerpted it for others like me who aren't fluent in #neurochemistry:

docs.google.com/document/u/2/d…
Read 4 tweets
Nov 23, 2020
It's hard to browse #library bookshelves from home. For other homebound readers, NYT best fiction 2009-19 as a thread for non-subscribers. (Your local library might let you read NYT etc on their website.)

Public libraries are my #SacredPlaces. #books nytimes.com/article/top-bo…
2019: DISAPPEARING EARTH Julia Phillips. THE TOPEKA SCHOOL Ben Lerner. EXHALATION Ted Chiang. LOST CHILDREN ARCHIVE Valeria Luiselli. NIGHT BOAT TO TANGIER Kevin Barry
2018: ASYMMETRY Lisa Halliday. THE GREAT BELIEVERS Rebecca Makkai. THE PERFECT NANNY Leila Slimani. Translated Sam Taylor. THERE THERE Tommy Orange. WASHINGTON BLACK Esi Edugyan.
Read 12 tweets
Nov 22, 2020
Holiday shopping from home? Support #Maine #Wabanaki businesses. The Wabanaki are the Maliseet, Passamaquoddy, Penobscot, Mi'kmaq, and Abenki People of the Dawn. #mepolitics #indigenous <thread>

#Passamaquoddy handmade moccasins facebook.com/PassamaquoddyF…
Who doesn't love a little syrup in their stockings? #Passamaquoddy maple syrup from #Maine. passamaquoddymaple.com/?fbclid=IwAR1V…
Meherrin Outpost is owned & operated by a Mi'kmaq (#Maine) & #Mehrrin (NC) couple. They make jewelry & sell a wide range of products from sage & sweetgrass to hand drums and (aw!) baby moccasins. facebook.com/meherrin/
Read 10 tweets
Nov 21, 2020
Even if they support the #DeathPenalty, most people think that only people who've killed should be killed.

🔴Prosecutors never claimed #DustinHiggs killed anyone, but #Barr has scheduled him to die 5 days before inauguration. Deeply moving video: /thread vimeo.com/194702182
#DustinHiggs was in his early 20s when he drove a shooter from a crime scene. Prosecutors said the shooter "acted alone," but they failed to get the #DeathPenalty. So they accused Higgs of being the mastermind.

The shooter got life w/ no parole. Higgs is to die on 1/15/21.
Jurors did NOT hear mitigating factors that might've led them to choose death in prison by no parole over execution. They didn't know he was 10 when he was his mother's f/t caretaker as she died of breast cancer. Nor did they know he has learning & developmental disabilities.
Read 4 tweets

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