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Stefan Kertesz, MD Profile picture
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10 Dec, 4 tweets, 3 min read
1/Bravo to Dr. @BethDarnall for stating (and better, helping lead a trial) ethical principles of a taper in which the patient is the agent, it's voluntary, and dose might go UP too. Thank-you @OldHeadFighta for the image in the next Tweet that captures the ethics here
2/Yes yes @OldHeadFighta - this gets at the reality that the principle is here is not just clinical but ETHICAL (and then I'll get to ethics)
3/The obligation upon clinicians is to treat the people in our care as full-fledged. Don't treat patients as means to an end, we wrote. Mandated dose reductions of opioids are "Not Justifiable Clinically or Ethically": pubmed.ncbi.nlm.nih.gov/32631183/
4/Our @OnHealer podcast tells a story of clinicians who lost track of what their goal was, and a patient who was nearly lost entirely- due protection for anonymity is made through altering some characteristics & use of a fictitious clinic.

pod.link/healer/episode…

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More from @StefanKertesz

Stefan Kertesz, MD Profile picture
11 Dec
We are eager to hear the plenary speaker for @US_ASP (the new academic pain org for the US) Dr. Meghani of U.Penn Nursing.. on the "Guideline Epidemic and Pain Care" introduced by @JessicaMerlinMD @DrJohnPereira /1
Key points for Dr. Meghani:
*US fighting its drug war "like other resource poor countries"
*Broad misapplication of the 2016
@CDCgov
opioid guideline
*Seriously undermined care of patients with mod to severe pain
*Obligations of policy makers in scaling high policies /2
Key points made by Dr. Meghani, of U Penn Nursing for
@US_ASP
Insurers and states acted rapidly, in 2016-17 after
@CDCgov
, to impose hard #opioid dose limits, to require opioid stoppage and taper, all in apparent violation of the Guideline, which had a low evidence GRADE /3
Read 5 tweets
Stefan Kertesz, MD Profile picture
9 Dec
Plenary: "The Evolving Relationship of Opioid Prescribing with Opioid Overdose and Suicide" - this topic will be presented of the new @US_ASP now by @AmyBohnert of University of Michigan - I'll share some points as they arise /1
Dr. Bohnert indicates she will focus more on overdose than on suicide because the combination of topics might exceed the time (and it would help to have suicide experts) /2
Opioid Rx and benzo Rx have been declining - for awhile, and for high-dose prescribing, etc. all of it is heading down @BrianMannADK of NPR please take note /3
Read 16 tweets
Stefan Kertesz, MD Profile picture
11 Nov
1/Last week we launched CSI:OPIOIDs, our research survey for bereaved families+friends who have lost a person with pain to suicide during a change in opioid prescribing. I want to say why this matters (fyi: it's at go.uab.edu/csiopioids ,or type URL if click-thru fails). First:
2/The recruitment letter approved by our ethical review board at @UABNews (called an IRB) is here: drive.google.com/file/d/19BRmWH…
3/Our team is inspired by the work of patients and families who have already come forward and spoken about this serious issue. We have been inspired by the painstaking efforts of people like @PainPtFightBack to record every death that comes to light.
Read 23 tweets
Stefan Kertesz, MD Profile picture
10 Nov
1/this study shows a massive shift to video and especially telephone care among Veterans after March of 2020. And it leaves me with key questions for vulnerable populations
2/The striking thing is not just the upsurge in non-face-to-face care but the reality that most of it was telephone 📞 only. What does that mean?
3/First in any safety net system lots of the people we wish to serve are older and poorer and potentially less comfortable with using video tech, or they may well lack the data plan and devices
Read 10 tweets
Stefan Kertesz, MD Profile picture
30 Sep
1/Canadian provinces that reduced #opioid prescribing the most also had the LARGEST increases in opioid overdose mortality in the 2-year period of 2016-2018 (r=0.63, p=.05, df=8) -it's striking to see significant correlations with n=10! bmcpublichealth.biomedcentral.com/articles/10.11…
2/The authors suggest that reductions in prescribed opioids create "supply gaps" that push the *non-medical opioid users* to riskier supplies.

However, I've become more concerned that some actual medical users (i.e. pain patients) also make that jump... like this:
3/In this Colorado case-control study, chronic opioid recipients who later developed new-onset heroin use were more likely to have had their prescription opioids stopped (38%) compared to those who didn't develop heroin use (22%) - sciencedirect.com/science/articl…
Read 8 tweets
Stefan Kertesz, MD Profile picture
25 Sep
1/In this randomized trial of 421, a Housing First approach ended homelessness for 86%, vs 36% for usual care. This was among extremely vulnerable persons- mental health ER visits ⬇️. No difference in acute hospitalizations or overall ER. Check 🔽
2/Some key points: for people who argue that Housing First will save 💰 due to reduced health care use, the data from trials are not consistently showing that. People who are really ill are still in need of health & social care when housed. But sometimes you reduce ED use
3/With @MKushel we spoke to the moral, ethical & financial proposition here in @NEJM in 2016 : nejm.org/doi/full/10.10… But to end “this person’s homelessness” the offer of some housing subsidy is our current strongest intervention for persons with long term homelessness
Read 5 tweets

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