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24 Oct, 4 tweets, 4 min read
.@mareasachs The good news is that you're at the peak of #migraine prevalence! Preventive treatment is always important, but especially so in people with childhood onset & women within a decade +/- of peak. n.neurology.org/content/68/5/3… Image
@mareasachs Thanks for your message! I'm rushing off now, but will check back in soon. If you're just starting to learn about #migraine, try @amfmigraine and .... americanmigrainefoundation.org
And check out this great interview by Angie Glaser (@winedarkme), who, like us, also started #migraine very young. She talks with another talented member of the #migraine sisterhood, @AbiStevens_Art. migraineagain.com/migraine-battl…
And if you're on Facebook, join us at @headsUPmigraine. We're a public group & welcome to anyone. We don't even make people have #migraine! We're the happiest bunch of miserable people on the internet! facebook.com/groups/6382986…

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More from @JillPiggott

Jill Piggott Profile picture
26 Oct
.@headsUPmigraine spoke w/ a rural #PCP hounded out of the profession by relentless pressure to stop rxing #opioids. She was the only PCP in +100 miles willing to accept patients on opioid therapy. Most were over 70. 2018 #AMA statement shows many share her frustration. >thread
In 2018, #AMA passed a resolution against “misapplication” of the CDC Guideline by “pharmacists, health insurers, pharmacy benefit managers, legislatures, & governmental & private regulatory bodies in ways that prevent or limit patients’ medical access to #opioid analgesia.” 2/
#AMA: "physicians should not be subject to professional discipline, loss of board certification, loss of clinical privileges, criminal prosecution, civil liability, or other penalties or practice limitations solely for prescribing #opioids" above CDC's recommended dose. 3/
Read 13 tweets
Jill Piggott Profile picture
21 Oct
@louisanamom In 2016, CDC said there wasn't good evidence showing reductions in rx #opioids would reduce ODs. Of their study of 221 #vets (who, sadly, have higher rates of OD/suicide), they said, "caution should be taken in drawing causal inferences from this observational study.” 1/
@louisanamom I don't know why CDC's 2016 paper is titled "a detailed exploration into the association of prescribed #opioid dosage & OD deaths" when it admits there were 2 low-quality studies + their "don't assume anything about cause & effect" study! ncbi.nlm.nih.gov/pmc/articles/P…
@louisanamom In 2016, @CDCgov had NO SOLID EVIDENCE about whether rx #opioid reductions & discontinuation would help or hurt. Here's their review of evidence (table 1). Read the column "Limitations."

By 2017, they knew it didn't reduce ODs. 1/ cdc.gov/mmwr/volumes/6…
Read 8 tweets
Jill Piggott Profile picture
1 Oct
@DrTomFrieden With all due respect, Dr. Frieden, why didn't you follow science when you directed @CDCgov & you learned in 2018 that fatal overdoses went up, not down, following implementation of the 2016 #Opioid Guideline you promoted? ncbi.nlm.nih.gov/pmc/articles/P…
@DrTomFrieden @CDCgov #CDC-funded research in 2018: “declines in these opioid prescribing metrics ... have not been followed by decreases in opioid overdoses. Instead, overdoses due to illegal opioids ... have increased.” Why didn't CDC retract the Guideline when it saw deaths were going UP?
@DrTomFrieden @CDCgov In 2016, #CDC Director Frieden told the press that the risks of rx #opioids would outweigh benefits for "vast majority of patients.” But the Guideline itself said an average 96% of patients had no addiction or non-addictive abuse, misuse, or long use.
cdc.gov/media/releases…
Read 15 tweets
Jill Piggott Profile picture
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
Jill Piggott Profile picture
16 Sep
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).
Read 12 tweets
Jill Piggott Profile picture
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

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