.@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/
#AMA's 2018 resolution directed the organization to contact pharmacy chains & insurers to “recommend that they cease and desist with writing threatening letters to physicians" when they prescribe #opioids for patients in #pain." 4/
#AMA's 2018 resolution directed the org to tell pharmacy chains & insurers to "cease & desist" with policies, procedures, & directives that set blanket bans on #opioid prescriptions above a predetermined dose in the absence of any clinical information. 5/
Rx #opioids are the most effective class of FDA-approved analgesic. #CDC's Guideline is based on an average 96% rate of unremarkable use (4% includes non-addictive misuse & "long use"). For many, opioids are the only treatment that allows them to work & care for family. 6/
A 2019 JAMA study found 40% of #PCPs refuse to accept patients who take an #opioid for #ChronicPain (link below). If patients can get a doctor & a script, they often can't find a #pharmacy willing to fill it, & humiliating pharmacy experiences are common. 7/
The OD epidemic is fueled by increasingly lethal illegal drugs. Taking medicine from a stable patient doesn't prevent someone else from using dangerous street drugs, & it increases the risk the patient will die of suicide or OD by as much as 6.8 times (Oliva). #Enough
American Medical Association House of Delegates. Inappropriate use of CDC Guidelines for prescribing opioids. Resolution 235. 2018. ama-assn.org/system/files/2…
40% of #PCPs refuse patients rx'ed #opioids. Lagisetty PA, Healy N, Garpestad C, Jannausch M, Tipirneni R, Bohnert AS. Access to primary care clinics for patients with chronic pain receiving opioids. JAMA Network Open. 2019 Jul 3;2(7):e196928-. jamanetwork.com/journals/jaman…
Oliva, Bowe, Manhapra, Kertesz, Hah, et al. Associations between stopping rx opioids & overdose or suicide deaths in US #veterans. BMJ. 2020 Mar 4;368. bmj.com/content/368/bm…
#Kushner wasn't "successful" til he got a WH job. He & #Ivanka owed $1.4 BILLION on their #mortgage til foreign investors prepaid nearly a century in rent. They got a self-serving taxcut into law & raked in $90 mil from undisclosed overseas sources, most Saudi Arabian. >thread
By the time #Jared & #Ivanka became White House Senior Advisers, they were a little late on their #mortgage. The Washington Post reported that by March 1, 2018, they owed $1.4 billion on 666 5th Avenue.
2 months after WashPost reported #Kushner owed $1.4 billion, a company "swooped in & agreed to take a 99-year lease on the building, paying a near-century’s worth of rent upfront." The #Qatar Investment Authority was a leading investor in the company. >3 nytimes.com/2018/05/17/nyr…
.@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…
@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."
@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…
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).