.@NBCJoshua Illegal, not medical, #opioid use fuels ODs, which have risen exponentially since at least 1979, predating more liberal prescribing patterns. Addiction & use aren't rising: people are taking increasingly lethal drugs & combinations of drugs. /thread
.@TheWeekMSNBC "Overprescription" isn't "fueling the OD crisis." @AmericanCancer says #addiction in medical use is "very rare." #CDC Guideline is based on an average 96% unremarkable use; 4% includes nonaddictive misuse & long use. Large studies put addiction rate under 1%. 2/
Canada's Guideline: 96.7% unremarkable use; 3.3% includes nonaddictive misuse & abuse, in keeping w/ #CDC's Guideline. Brat et al. found a 99.4% rate of unremarkable use in more than 1 million post-op opioid scripts. 0.6% included people who refilled their scripts (BMJ 2018). 3/
Ciesielski et al. found a rate of 99.7% non-addictive use & identified readily available information that can be used to predict the likelihood of abuse (American Journal of Med 2016). (Direct links at end of thread.) 4/
By its own admission, #CDC never had solid evidence that reducing prescription #opioids would reduce ODs. See Guideline Table 1: Grading of evidence. Read the column "Limitations." 5/ cdc.gov/mmwr/volumes/6…
By 2017, #CDC admitted that "declines in #opioid prescribing metrics ... have not been followed by decreases in opioid overdoses. Instead, #overdoses due to illegal opioids (heroin, illicitly manufactured fentanyl) have increased" (Bohnert et al 2018). 6/ ncbi.nlm.nih.gov/pmc/articles/P…
In the 2018 study linked above, #CDC researchers identified OD as the outcome “of greatest interest to public health." You'll find their admission that reductions in #opioid scripts were followed by increases in ODs at the end of the 8th paragraph in the Discussion. 7/
0.1 to 0.2%: Multiple studies & national guidelines find the same risk of OD to prescribed #opioids: one-tenth to two-tenths of 1% (Canada 2017).
300% = Increased risk of OD from dose variability of 30%, which is common in tapers & forced discontinuation (Glanz, JAMA 2019).
2,887 #vets died of OD or suicide after their #opioid medicine was stopped in FY2013. That's only 90 fewer deaths than on 9/11. Discontinuation puts people at up to 6.8 times increased risk of death compared to continuing treatment (Oliva et al BMJ 2020). bmj.com/content/368/bm…
Of course, #opioid prescription restrictions don't just kill people. They also disable them unnecessarily and/or cause them to terminate all medical care.
✔️Rx #opioid limits don't protect people w/ #addiction from OD to illegal drugs, & they increase OD & suicide in people w/ #pain. Doctors should determine risk/benefit for individuals. Lawmakers & insurers should let them do their jobs. Factsheet: docs.google.com/document/d/e/2…
Thanks to @NBCJoshua for noting that #ChronicPain patients have a "legitimate need" for rx #opiods. If @TheWeekMSNBC would cover the story from the perspective of people w/ #pain, we'll happily provide contacts for interviews & additional info. See thread above--@JillPiggott
🔴HOW DOES THIS CHILD GO 8 YEARS WITHOUT A DIAGNOSIS? She has textbook ICHD-3 #migraine! 1>sudden hypersensitivity (smell) 2>throbbing #pain 3>nausea 4>need for bedrest
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
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.”
New OFFICIAL Classification of Diseases: #Migraine is not chronic 2ndary pain ("a symptom of an underlying condition") but chronic primary pain ("disability or emotional distress" not "accounted for" by a condition of “known etiology or established pathophysiology") >thread
#Migraine & #cluster are now officially classified as chronic primary pain (disability & emotional distress not accounted for by an underlying condition), not chronic secondary pain "where pain may at least initially be conceived as a symptom secondary to an underlying disease."