After listening to NPRs new podcast episode with kolodny and others on How to fight the opioid epidemic I came across many things that were problematic but the two issues that stuck out to me I will highlight below...
The 1st issue I had was kolodny’s narrow view of addiction.. Throughout the episode we heard tragic stories of people succumbing to addiction and dying of overdose.. In these stories we heard how they suffered with substance abuse issues, psychiatric issues, also people with
Socioeconomic issues as well.. Instead of discussing all these factors and how they can attribute to why someone can succumb to addiction kolodny wanted to focus on 1 thing being the main catalyst: Prescription opioids.. Dr. Carl Hart who is a neuroscientist has been doing some
great work in regards to studying drug exposure and addiction.. He mentions how the majority of people who take legal and illict drugs don’t end up becoming addicted.. He mentions how we have to talk about other factors as I have listed above instead of focusing simply
on drug exposure.. I agree with him 💯... to focus only on drug exposure is to miss out potentially on different things we could be helping the patient with (mental health, socioeconomic status etc).. The 2nd main issue that shocked me the most was his conflation of those who
have chronic pain issues vs those who succumb to substance abuse.. (caveat there are those who both have chronic pain and substance abuse issues as well).. At one point there was a caller who suffered with pain, and he made a comment about how he needed access to
Opioids for his painful condition and he was having a hard time getting it and he was being treated like a criminal for needing pain meds for his severe condition.. Kolodny’s response to this pain patient is below not the full quote but a partial quote
“Patients with pain have been disproportionately harmed by aggressive overprescribing of opioids, millions have become addicted, thousands have lost their lives. It’s not as if we HAVE THESE 2 DISTINCT GROUPS (emphasis mine). So I do feel we can do a better job of treating pain
but that doesn’t mean that opioids are the answer”.. when I heard him say that I was pretty shocked.. Instead of addressing this pain patient about their pain he lumped him in with those who become addicted and end up losing their life.. He stated there are no 2 distinct groups
This really flys in the face of millions of chronic pain patients who have no prior psychiatric issues, or issues with abuse who rely on opioids for relief (sickle cell, EDS,AA etc).. I think it’s really dangerous to not make a difference between these groups of
Patients and lump them all together in my opinion. I thought these were the 2 major issues I had with it. It’s sad Mr. Kolodny is controlling this narrative with his narrow minded views but hopefully some real change can come one day in regards to changing the narrative #TwitteRx

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More from @GhanaboyPharmd

11 Jun 20
Thread***

Sickle cell disease will always be a disease that means so much to me.. Growing up seeing my brother battle with this disease was hard. Many nights my family would be in the hospital with him watching him in excruciating pain. Many nights i would see the
stress on my parents face as their youngest son was going through horrific pain. Sometimes i would pray that God would take this disease away from my brother and give it to me so he wouldn't have to suffer anymore. #sicklecell patients already have it hard enough
with this disease now add on top of that racial bias that they have to deal with. Many times either me or my dad would have to advocate for him in the ER to get proper and urgent care and make sure his pain is adequately managed... The treatment my brother has received
Read 6 tweets
10 Mar 20
I truly feel for those who suffer with addiction and i am glad we have medications and tools to help with that as well.. It is truly devastating to lose someone to addiction and i hate hearing stories about it. I also have the same type of compassion for those
who suffer with chronic pain. My brother has #sicklecell and he suffers with chronic pain. Whenever he has his crisis he suffers excruciating pain that cuts deep to the core... We have a class of medications called opioids that have helped patients in pain for centuries..
It saddens me to see people demonize this class of medications which Have helped so many people cope with their pain. Yesterday I was taking care of this lady in our hospital who was going to be going to hospice the next day
Read 6 tweets
8 Mar 20
Thread on the opioid crisis****

I came across this article in the Journal of Pain Research by Dr. Jeffrey Singer et al. The title is called "Today's Nonmedical opioid users are not yesterday's patients: implications of data indicating stable rates of Nonmedical use and pain
Reliever use disorder". If you Havnt read this i would highly recommend it. When we discuss the opioid crisis we like to assign more blame to certain entities. The entity i hear alot in this discussion is pharmaceutical companies like Purdue Pharma and overprescribing that
Took place during the 90s when they marketed the drug Oxycontin. Alot of times we hear they were the cause of this crisis along with doctor overprescribing. Now this was Definately a contributing factor in getting this drug in the wrong hands resulting in NON-MEDICAL use
Read 7 tweets
1 Feb 20
Excerpt from article A Painful reality: Unequal access to Opioids in Developing Nations

"It is clear that the ripples of the American opioid epidemic are being felt around the globe. Because of this epidemic the word "opioid" has acquired a harshly negative subtext. Legislators
And philanthropists in the developing world are now opposing the import of opioids out of fear that increasing availability will trigger another epidemic of addiction abroad. Meg O'Brien founder of Treat the pain, a group devoted to bringing palliative care to developing
Countries believes this "opiophobia" is illogical. As she stated in a recent interview, "The U.S. also has an obesity epidemic, but no one is proposing we withhold food aid from South Sudan". The most recent World Health Organization List of Essential Medicines
Read 5 tweets
19 Jan 20
Pharmacy education post***

Why are the benzodiazepines Lorazapem, Oxazepam, and Temazepam recommended in the elderly?

Benzodiazepines are metabolized either through Phase 1 or Phase 2 metabolism
Phase 1 metabolism includes for example oxidation or reduction and turns the parent molecule into a more polar compound and eventual inactivation of the drug. Phase 1 metabolism involves the enzymes CYP2C19 and CYP3A4 and are responsible for benzos that undergo Phase 1..
Phase 2 metabolism involves conjugation of charged compounds and makes it more water soluble facilitating it into the bile or urine. So Phase 1 metabolism tends to decrease in the elderly and Phase 2 metabolism is for the most part preserved..
Read 5 tweets
12 Jan 20
Excerpt from article:

A crisis of opioids and the limits of prescription control: United States
Stefan G. Kertesz & Adam J. Gordon:

"First, people who misuse opioid medications usually report they were not obtained for care of themselves. Such reports buttress a concern
That many were prescribed unnecessarily. Secondly, heroin addiction may not begin with medication. Among people with heroin OUD in the 2012-2013 National Epidemiologc Survey on Alcohol and Related Conditions (NESARC), the percentage who started with non- medical use of
Prescription type medication was 53% for whites and 26% for non whites. Similarly among people entering opioid treatment programs, the percentage who reported first using heroin (as opposed to pain medication) for getting high rise from 8.7% in 2005 to 33.3% in 2015
Read 4 tweets

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