Stefan Kertesz, MD, MSc Profile picture
Sep 21, 2020 6 tweets 2 min read Read on X
1/Opioid crisis roars back in Alabama as overdoses rise during pandemic - 32% rise in Jefferson County (where Birmingham sits). Loss of human contact is part of the story told by Cassidy Cooper and me. al.com/news/2020/09/o…
2/Cassidy has lost 6 friends in the Huntsville area. He finished a rehab program in March:"Restrictions enacted to prevent the spread of coronavirus quickly dismantled the scaffold he built around his recovery. The gym he visited daily closed and support groups moved online."
3/ I say:

"There are people where holding their lives together and getting help really depends on going up to trusted friends and seeing them face to face, and the pandemic really takes that away,” Image
4/Pandemic conditions also affect naloxone distribution and drug distribution networks. The question is what can we do? The aggressive use of masks should allow us to ramp up naloxone distribution & tele-treatment. But social networks are not just made of state & county programs.
5/To the extent that we all do our utmost to prevent further viral spread, we actually can help to bring about conditions where reduced community spread allows social groups to reconnect. In the meantime I keep wondering about free phones, "call a friend", and drug testing.
6/I'm a proud member of @cappi_uab and @UABNews

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More from @StefanKertesz

Mar 15
1/A petition has been filed with the FDA, asking it to assess whether the "Narxcare" algorithm, which is part of prescription drug monitoring programs, should be regulated as a medical device.
FDA has rules, ones that suggest the petitioners are correct, and I signed this one Image
2/The Narxcare algorithm is a proprietary calculation that purports to capture overdose risk.
When docs check prescription drug monitoring programs, the score appears prominently at the top of the report, as if it should influence the prescribing decision.
3/Next Tuesday, our "On Becoming a Healer" podcast will be all about the study of how prescription drug monitoring programs influence health professionals. Special guest: @Liz_Chiarello She wrote a whole book on it! Image
Read 10 tweets
Feb 10
1/I am so thankful to @undarkmag for our interview on how opioid prescribing changes relate to the key question:

“How are we really going to take care of people with disability and pain who have been traumatized by our own health care system?”Image
2/The popular narrative was that the opioid crisis of 2016 reflected a whole bunch of patients with long term pain evolving into heroin users

The power of this narrative led to some bad policy and practice adjustments Image
3/The CDC’s 2016 Guideline was routinely mis-cited (yes, inaccurately cited) by federal agencies and law enforcement

Where the guideline permitted careful justification for a decision, the enforcers never didImage
Read 9 tweets
Jun 5, 2024
🧵1/Our @uabmedicine Grand Rounds will feature a diagnostic showdown between Dr Martin Rodriguez and ChatGPT4

I am scared here because I don’t want AI to win Image
2/the case features behavioral changes, swearing, cognitive decline, cough, progressive weakness over 3 years.

I wonder about infectious and rheumatic disorders. Maybe primary neurological

Aspirations after a cognitive change is possible

Dr Rodriguez opens. Not much to go on. Image
3/ChatGPT generated a lot of text read by Dr Kraemer but it is pretty good, with emphasis on neurological disorders followed by a disclaimer “please note that this does not substitute for professional medical advice”. Both want more information
Read 15 tweets
Nov 15, 2023
Truth💣
1/ The “NARXCare” opioid Rx risk algorithm is in all Prescription Monitoring Databases,ie ~1 bn Rx’s/year

NOW in @JournalGIM
✅evidence does not yet exist to support it as safe or protective
✅It has flourished due to lack of federal oversight
link.springer.com/article/10.100…
Image
2/The authors, led by Dr Michele Buonara, review the core argument as one in which this algorithm with low evidence to its favor

and high risk of harm

has gone unregulated

despite apparently fulfilling @US_FDA criteria that mandate it be regulated Image
3/Nearly all prescribers and national pharmacies now see the Bamboo Health, Inc proprietary “NARXcare” algorithm in a more prominent position *than the prescription history itself” when they view a prescription history. Image
Read 10 tweets
Nov 3, 2023
1/Arguing for methadone deregulation, Dr. Ruth Potee notes that in an auditorium of 400 addiction specialists, almost NONE prescribe methadone (because they can't)

"Methadone is a miracle drug that no one has access to"

There are more people who offer Botox than offer methadone
2/With most blood pressure and anti-cholesterol meds, the number needed to treat to save one life is well over 100

With methadone, it’s 40

Number needed to treat to improve a life=1 #AMERSA2023
@AMERSA_tweets 3/Regulations for methadone care have not changed in 50 years.

How many other aspects of health care have not changed one bit in 50 years?

In the map: access to methadone care is almost completely absent in extremely large parts of the country.

-Dr Potee Image
Read 31 tweets
Sep 24, 2023
1/For patients on opioids, weighing “risks vs benefits” with shared decisionmaking – as CDC urged- may be out of reach for today’s doctors & patients.

Writing in @SAj_AMERSA @PoojaLagisetty & I propose weighing Harms of continuing vs Harms of reducing
A🧵
journals.sagepub.com/doi/10.1177/08…
Image
2/Opioid Tapering has proven a mixed bag. Research finds some patients ⬇️doses with no harm, but others suffer catastrophes

The CDC urged “shared decision-making” about risk & benefit

But for opioid BENEFITS, docs & patients routinely disagree cdc.gov/mmwr/volumes/7…
3/A patient may report an opioid benefit

Patient: “I can still do my activities”.
Doc: "No way, not really. I read the SPACE trial, and there is NO benefit (that would outweigh the opioids’ risk)”
"Shared decision-making" seems *doomed* here Image
Read 12 tweets

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