***Thread***

I don’t know how folks continue to take her seriously but George Floyd DID NOT die from a drug overdose.. The autopsy said he had 11ng/ml in his system based on the postmortem reports.. First of all you can’t properly determine antemortem drug concentrations
based solely on postmortem drug concentrations.. It is highly variable and many factors need to be understood as shown below.. Utilizing the postmortem data alone to characterize Floyd as a drug addict does not correlate. Image
So let’s discuss the level of fentanyl he had in his system which was 11ng/ml. Is this a fatal level? As was mentioned above to base this postmortem level as if this accurately describes his antemortem level is not correct. As I mentioned the postmortem data is highly variable
As you can see in this study below postmortem levels can range from 1-102.2 ng/ml which is a huge range.. Image
In this study above they showed that the illicit death group had a mean concentration of 26.4 ng/ml and the natural group had 11.8ng/ml (Floyd had 11ng/ml remember).. Image
Other studies have shown other concentrations of postmortem fentanyl levels for the illicit group being other levels shown below Image
The same study mentioned once again the reason why it is important to understand why basing antemortem levels off the post data without regarding all these factors will not be accurate (drug in this study was transdermal fentanyl) Image
So as we see postmortem fentanyl levels very widely and the level George had in his system has shown to be normal in several studies.. The question is was George exhibiting respiratory depression symptoms before the officer put a knee on his neck? Nope not at all..
Floyd was obeying commands, when told to sit, he sat, when told to get out of the car he did, he was even yelling out he couldn’t breathe when the officer had his knee on him.. He was not displaying respiratory depression symptoms. Each individual will have a different tolerance
Level to opioids. some will tolerate higher doses than others.. Another autopsy the family got stated it was a homicide. So George was not a “junkie” he didn’t die of a drug OD.. No he died when the officer placed a knee on his neck for over 8 minutes

#JusticeForGeorgeFloyd Image

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More from @GhanaboyPharmd

28 Mar
Kolodny frequently states that just because Rx opioids have declined around the same time as increases in overdose deaths climbed up doesn’t mean A caused B.. It’s ironic in his lecture below he states that around the same time opioid sales went up as well as opioid death and
addiction and one caused the other. These all happened around the same time but does that mean one caused the other? Correlation doesn’t equate to causation right? it’s interesting he says that regarding decrease in Rx opioids and increase in ODs, but doesn’t apply the same logic
in his lecture above.. Why is that? It’s because his worldview is so focused on Rx opioids being the cause of everything in this crisis that he doesn’t stay consistent in his reasoning.

#TwitteRx
Read 4 tweets
25 Mar
Looks like more people are asking all the right questions..
👀 👀
Read 4 tweets
24 Mar
Another crazy aspect of kolodny lecture with @Pharmed_Out yesterday was when he stated in the beginning of his lecture that one of the wrong ways to frame the opioid crisis is to focus mainly on overdose deaths and the drugs involved. As a pharmacist who works in the hospital I
Cringed so hard at that statement.. When a patient comes in the ER with an OD situation its kind of important to know what drug is involved so we can give proper treatment (opioids, beta blockers, Tylenol etc).. Also its very important to know what drugs are involved because
Its important to understand what source, and the nature of the overdose.. Is it from an illicit or an Rx source? Also how many drugs were involved.. A person may have uses an Rx but also combined many other illicit drugs that ultimately caused the death.. Also
Read 5 tweets
1 Mar
***Thread***

Are medications like oxycodone and hydrocodone essentially heroin pills??

Kolodny recently did a townhall discussion last year on the opioid crisis and COVID... and he made some interesting assertions regarding the semi synthetic medications like oxycodone
He stated when you make molecules like oxycodone, hydrocodone you’re essentially making drugs that cross the BBB easier and are more lipophilic. He continued in the video clip above and stated that they are like heroin in creating a rewarding effect due to it crossing the BBB
His assertion that semi synthetic pain medications such as hydrocodone, and oxycodone are essentially “heroin pills” I think is somewhat hyperbolic and I will try to explain why below...

Molecules like heroin, hydromorphone, oxycodone, etc even though they are made to target
Read 10 tweets
26 Feb
Interesting study done last year looking at the toxicology OD data in British Columbia, Canada.. “They identified by the BC Coroners Service in 2015–2017, were linked to the prescription drug histories of individuals as recorded in BC’s PharmaNet database”
What I like about this descriptive analysis is that they disaggregated the OD data in order to see what drugs were involved in Overdose deaths.. Usually a lot of times you see reported in the media this number so and so died of drug overdose, but what you don’t see reported is
The data disaggregated in order to figure out what drugs were involved.. The chart below shows that from the sample only about 2% of deaths involved prescribed opioids alone in the absence of non-prescribed opioids. The majority of OD deaths involved non prescribed stimulants, Image
Read 6 tweets
25 Feb
***Thread***

Dependence vs Addiction

I have been seeing this flyer around social media and i wanted to do a quick thread on the difference between the 2.. I think alot of times we tend to mesh these two concepts together or often conflate these terms which can
Cause issues as well.. To start off this flyer states "If you get prescribed opioids, you may end up wishing you hadn't. That's because anyone could become dependent on painkillers like hydrocodone, oxycodone, and fentanyl which can ruin your relationships, health and career"
So this flyer states that dependence can happen when taking opioids Which can cause you to ruin your relationships, career, etc.. So what is dependence? It is considered when you have physical or physiological dependence it is indicated by tolerance and withdrawal symptoms.
Read 8 tweets

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