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

17 Sep
@carmenxbrook #MedicareForAll Act of 2019: Introduced in the House 2/27/19.

House members who support the bill: 118. Number of additional House members needed for passage: 100.

congress.gov/bill/116th-con…
@carmenxbrook #MedicareForAll Act of 2019: Introduced by #Bernie 4/10/19.

Senators who support the bill: 15. Number of additional Senators needed for passage: 45 w/ filibuster, 36 w/o filibuster. congress.gov/bill/116th-con…
@carmenxbrook IF #Republicans hold the Senate, NO #healthcare bills will pass. McConnell & the GOP are killing 400 bills, most bipartisan, passed by the House incl'g multiple bills on rx drug prices, #vets' healthcare, preexisting conditions. See the list here: threadreaderapp.com/thread/1305516…
Read 13 tweets
15 Sep
#Opioid tapering is "extremely difficult" for people w/ #ChronicPain, "not only in those w/ problematic opioid use."

Kurita: Worsened pain &/or function led more than half of those studied to stop scheduled dose reduction of 10% or 20% per week. /thread onlinelibrary.wiley.com/doi/full/10.10…
1b/ Kurita: Altho 40 of 75 didn't complete the taper, researchers found "improvements after opioid treatment stabilization was achieved," suggesting stabilization (whether at a dose or at 0 dose) is a preferable goal to forcing everyone off rx #opioids.

Stopping can be fatal.
2/ Glanz: "Attempts to adhere to prescribing guidelines may lead patients to be exposed to variability in #opioid dosing." Dose variability of 30% or more increases the risk of overdose more than 300%.

Glanz et al. JAMA Network Open. 2019;2(4):e192613.
jamanetwork.com/journals/jaman…
Read 16 tweets
14 Sep
🔴 Senate #Republicans have KILLED 400 bills passed by the House, most w/ GOP votes. #Dems need to win 4 seats (3 if #Harris is VP). 6 races are tossups: CO-Gardner, GA-Perdue, IA-Ernst, ME-Collins, MT-Daines, NC-Tillis.

thread: Bills Killed by Senate GOP newsweek.com/mitch-mcconnel…
🔴 BIPARTISAN Bills PASSED by the House but KILLED by Senate #Republicans:

Climate Action Act
Raise Minimum Wage
Violence vs Women Act
Corporate Transparent Act
Enhanced Background Checks
Gold Star Family Relief Act
Save the Internet Act
Equality Act
🔴 BIPARTISAN Bills PASSED by the House but KILLED by Senate #Republicans #2

Paycheck Fairness Act
Protect Preexisting Conditions Act
Lower Prescription Drugs Act
Ban Offshore Drilling Act
Invest in Maine Street Act
Lower Prescription Drugs Act #2
#STEM education
Read 45 tweets
5 Sep
Now we know Trump mocked a man's #disability because he feels "disgust for those who have suffered." As president, he told staff "not to include wounded #veterans" in an event because “Nobody wants to see that."

Trump's views of #vets: reporting from @TheAtlantic (thread)
.@FoxNews @AP & other media organizations have verified @TheAtlantic's reporting that Trump lied when he said he couldn't reach a French cemetery to honor America's war dead. In fact, "he feared his hair would become disheveled in the rain."
“Why should I go to that cemetery? It’s filled with losers," Trump told senior staff members," referring to America's WWI fallen. During the same 2018 trip, he referred to the "more than 1,800 marines who lost their lives at Belleau Wood as 'suckers' for getting killed."
Read 22 tweets
4 Sep
How anyone who respects #vets wouldn't crawl thru mud to #VoteBiden is beyond me.

After reading Trump's shameful comments, I Googled the name of the #POW whose name I wore on my wrist for years. What I learned couldn't stand in starker contrast to @realDonaldTrump.
#POW Cpt Lynn Guenther was shot down & spent 14 months in the infamous Hanoi Hilton. He said the experience taught him "the real meaning of tolerance and love - tolerance for those around us and love for the country and world we live in" (link below). nara.getarchive.net/media/former-p…
.@realDonaldTrump You didn't avoid #Vietnam b/c you were a Conscientious Objector. You cooked up a #bonespur because you're a coward & have no commitment to serving others. Here's the #POW whose name I wore on my wrist during the War. nara.getarchive.net/media/former-p…
Read 16 tweets
1 Sep
⭐️ HUGE⭐️ victory for people with #ChronicPain in #NewHampshire AND their doctors. New bill protects the right of #pain patients to #opioid medicines AND protects the doctors who prescribe them.

Bill is MODEL legislation for other states. /thread painnewsnetwork.org/stories/tag/Ne…
New NH law: If people "on a managed and monitored regimen of #opioid analgesic treatment" have "increased functionality and quality of life as a result of said treatment," the "treatment shall be continued if there remains no indication of misuse or diversion.”
Under the new law, "physicians & pharmacists are required to consider the 'individualized needs' of #pain patients, treat them with dignity, & ensure that they are 'not unduly denied the medications needed to treat their conditions,'" including (specifically) #opioids.
Read 12 tweets

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