Thread by @headsUPmigraine

Risk of OD to prescribed #opioids is 0.13% (Kaiser, Jnl of Pain 2019), while risk of death by OD increases more than 300% with dose variability of ≥30% (JAMA 2019).

VHA study: discontinuation increases the risk of death by #OD or #suicide up to 6.8 times (BMJ 2020). / thread

https://twitter.com/JillPiggott/status/1319707524128493572

0.13% = risk of OD to prescribed #opioids (Kaiser 2019). Dose reduction is "inconsistent" in lowering OD risk. Research found "no support for RSM [risk stratification & monitoring] as a means of decreasing overdose.”

Jnl of Pain 2019;20(1) jpain.org/article/S1526-…

0.1% to 0.23% = risk of OD to prescribed #opioids, per Canada's 2017 Guideline.

0.1% for <20 MED, 0.14% for 20–49, 0.18% for 50–99 MED, 0.23% for ≥100 MED.

Discontinuation carries a significantly higher risk of death.
#PCP #MedicalTwitter
ncbi.nlm.nih.gov/pmc/articles/P…

High-dose variability (>27.2 MME) more than triples the risk of OD. "Practitioners should seek to minimize dose variability when managing long-term opioid therapy."

#MedicalTwitter #PCP
Glanz JM, et al. JAMA Network Open. 2019;2(4):e192613.
jamanetwork.com/journals/jaman…

2,887 #vets died of OD or suicide after their #opioid was stopped in FY2013. 1 year of VA policy=90 fewer deaths than 9/11.

Stopping treatment was associated w/ an increased risk of fatal OD/suicide of up to 6.8 times that of patients who continued to be treated (Oliva 2020).

Risk of fatal #OD/#suicide is associated w/ stopping rx #opioids regardless of the length of treatment & is highest in 1st 3 months after discontinuation.

Oliva, Bowe, Manhapra, @StefanKertesz, et al. BMJ. 2020 Mar 4;368. bmj.com/content/368/bm…

4.9% of people whose rx #opioid was stopped died of OD, while 1.75% of those whose rx continued did.

Stopping COT was associated w/ 3 x the risk of fatal OD. Most patients have at least 1 MD-initiated discontinuation.

James et al. Jnl Gen Int Med 2019 link.springer.com/article/10.100…

Rx #opioid limits have "failed" to reduce ODs, which are fueled by increasingly lethal illegal drugs. Modeling shows limits will have a "modest effect, at best" going forward. Evidence shows harm reduction, not rx limits is needed. Chen et al., JAMA 2019.
jamanetwork.com/journals/jaman…

The exponential rise in ODs began in 1979, & without fact-based policy, 1.21 millions Americans will die of overdose 2015-25.

The evidence is clear: rx #opioid limits kill people w/ #pain & #addiction. They accelerate ODs. #Enough

@NitaGhei @JillPiggott @threadreaderapp unroll

#cpp #ChronicPain