I can’t remember who asked for this, but I found my pdf of the abstract w/ notes on it that you had wanted for:
“Assoc of Opioid Prescribing Patterns w/ Rx Opioid OD in Adolescents and Young Adults.”
This is from last year so not new but still good to bookmark.
Of 2,752,612 pts ages 12-21 who weren’t being treated for cancer & filed at least 1 opioid Rx from 7/1/2009 to 10/1/2017, there were:
-4,686,355 ins claims for opioid meds (aka prescriptions)
-Of these 21,605,444 person-days, OD’s occurred on 255
person-days.
-249 patients experienced OD’s so a few individuals OD’d
more than once.
Bottom line:
-0.01% of the 21,605,444 pts in the sample experienced
overdose event (aka one hundredth of 1%)
-One hundredth of 0.01% translates to 1 overdose for every
10,000 patients ages 12 to 21 who filled at least one
prescription for an opioid.
Bottom line cont’d:
-Despite the incidence of OD being small overall,
the authors caution that higher opioid doses, ER opioids,
simultaneously prescribed benzodiazepines result in a
greater risk of OD
1/ Patient & sociologist Dr. Elizabeth @JoniakGrant was on committee & spoke several times during the day.
Here she talked about:
a. Avoiding further harm in pts w/ pain
b. Pts have been forced to taper, are unable to find prescribers, or struggle to get Rx filled
2/Cont’d:
c. Pts aren’t trying to “climb mountains,” they want to be able to do the simple necessities (ADL, caring for children, spend time w/ family, work if poss) many ppl take for granted.
d. We can no longer excuse harms to pts from “unintended consequences”
3/ Cont’d
e. Study opioid benefits. Little focus focus on benefits of opioids or harms of forced tapers beyond acknowledging risk for suicide.
f. Along w/ OUD risk, we must recognize many pts feel opioids help them.
D/C’ing opioids can cause harm on par or > than OUD.
1/ Another patient being tapered off of opioid therapy, another hash mark for PROP!
20’s male, with Duchenne Muscular Dystrophy, on non-invasive mechanical ventilation, dilated cardiomyopathy. Pain from broken hardware following failed fusion. Opioid x 10 yrs. 300 MME.
2/ Some finger movement, able to work in graphic design, but requires attendant care 24/7. Care transferred to PM group affiliated w/ hosp. This MD stated it was “illegal to continue opioid w/o functional improvement.
3/ Initial dose cut was 25%. 2 weeks later pt has not tolerated taper well.
⬆️ pain
⬆️ difficulty breathing
⬇️ sleep
MD said he would be “a nice guy and go easy” *only* dropping dose by 20%.
@daveys35 @Faithgirlee @SpicyPurritos @CarolKennon4 @lil23rdss @plwin49 @KatMelcher @crystalmurphy28 @RogueWolf2001 @ASanchezs65 @ezmirellda @Shadybug60 @MartineBeaumie8 @ThomasKlineMD @MaryinKansas @TerryColey5 @sexton_cecilia @Irishbrat1966 @sureuwanttoknow @shdwstar @Bilked2TheBrink @kaake_rn @bitchin_p @CContrarus @shounenrobot @ladiekerrie @OpioidHysteria @PainSteals @KatTwisted @kirsten_klang @WizardPuzzle @humanedrug @VIoletTailor @SpartanRyan13 @JSG_54 @PainPlayhouse @RachaelHorning @katman_steven @ForensicMHSA @WandaMoCats @BlkBettyALBurn @Madeinavalon @VelaRosieZazu @Pain_Speaking @VintageVamp17 @puppyluvr312 @Mary86802059 1/ David, I apologize for not seeing this sooner. I had commented on another thread, it was kind of long-winded but I’ll try to be more concise & focus just on what you asked here. I’ve read the FTCA and I know you have too - along w/ putting tons of time & effort into this.
@daveys35 @Faithgirlee @SpicyPurritos @CarolKennon4 @lil23rdss @plwin49 @KatMelcher @crystalmurphy28 @RogueWolf2001 @ASanchezs65 @ezmirellda @Shadybug60 @MartineBeaumie8 @ThomasKlineMD @MaryinKansas @TerryColey5 @sexton_cecilia @Irishbrat1966 @sureuwanttoknow @shdwstar @Bilked2TheBrink @kaake_rn @bitchin_p @CContrarus @shounenrobot @ladiekerrie @OpioidHysteria @PainSteals @KatTwisted @kirsten_klang @WizardPuzzle @humanedrug @VIoletTailor @SpartanRyan13 @JSG_54 @PainPlayhouse @RachaelHorning @katman_steven @ForensicMHSA @WandaMoCats @BlkBettyALBurn @Madeinavalon @VelaRosieZazu @Pain_Speaking @VintageVamp17 @puppyluvr312 @Mary86802059 2/ I’m basing this on the (a) reading I’ve done, (b) input from several attorneys (including 1 who has won FTCA cases), and lastly (c) the written explanation Mr. Chapman provided you. His opinion should carry the greatest weight of the 3 sources.
@daveys35 @Faithgirlee @SpicyPurritos @CarolKennon4 @lil23rdss @plwin49 @KatMelcher @crystalmurphy28 @RogueWolf2001 @ASanchezs65 @ezmirellda @Shadybug60 @MartineBeaumie8 @ThomasKlineMD @MaryinKansas @TerryColey5 @sexton_cecilia @Irishbrat1966 @sureuwanttoknow @shdwstar @Bilked2TheBrink @kaake_rn @bitchin_p @CContrarus @shounenrobot @ladiekerrie @OpioidHysteria @PainSteals @KatTwisted @kirsten_klang @WizardPuzzle @humanedrug @VIoletTailor @SpartanRyan13 @JSG_54 @PainPlayhouse @RachaelHorning @katman_steven @ForensicMHSA @WandaMoCats @BlkBettyALBurn @Madeinavalon @VelaRosieZazu @Pain_Speaking @VintageVamp17 @puppyluvr312 @Mary86802059 3/ You’re 100% correct that FTCA provides a means to seek damages in the event of bodily harm. I’m going to link the text of the FTCA here for anyone wanting to read the full document.
@daveys35 1/ I so wish you had the grounds for FTCA and that you had attorneys fighting over your case left and right. Attorneys are hyperfocused on avoiding malpractice (docs aren’t the only ones who have to worry about this) or bar complaints.
@daveys35 2/ At large firms it’s often a paralegal or very new atty that reviews a case. They would be unwise to say someone doesn’t have a case (esp if a paralegal), this is “legal advice” and attorneys are held responsible for the counsel their firm provides.
@daveys35 3/ Next, time spent on a case once they know they won’t take it is a poor use of resources. Therefore attys & their staff try to figure out if they are interested in digging into a case ASAP or they move on.
@aander1987 1/
Ferreira & colleagues (2023) found that antidepressants aren’t the panacea for pain many of us hoped for. 11 /42 studies showed benefit. 31/42 studies failed to find benefit or results were inconclusive. (cont’d) bmj.com/content/bmj/38…
@aander1987 2/ From their research, SNRI’s seem the most likely to be beneficial, but prescribers need to select pts with diagnoses likely to be responsive:
back pain
post-op pain (this one surprised me)
neuropathic pain
fibromyalgia bmj.com/content/bmj/38…
@aander1987 3/ Babazade & colleagues (2019) found that IV opioid PCA was the “optimal strategy regarding cost” when compared to liposomal bupivicaine or epidurals.