2/As we pointed out then, rapid deployment of funds in compliance with federal law is actually a tough lift- outreach across entire communities and new points of access were and ARE needed al.com/news/birmingha…
3/Counties and cities should be reporting to the public and the Congress - at least weekly- what dollars have been committed and what ones have not. That is part of accountability
4/They should set aside portions of funds to market even more than many have already done- including to police and sheriffs, to legal counsel. This is the perfect court diversion program - hand money out and prevent the eviction hearings in the first place!
5/Cities or states that engage in large scale evictions from rented hotel space need to recognize that their prior shelters are often insufficient because (a) families can’t use most shelters (b) are traumatic (c) Delta variant viral spread
6/Mayors & County officials: you can make the difference! Demand someone in your office *report to you daily on money allocated & where you can help*
*put your face on TV and social media saying “we have the money for ya’!”
Create Impetus-
Stop the next homeless wave 🌊 NOW /end
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1/This @thedailybeast piece offers "medication counts" as *the key* to patient safety & health. Taken seriously, it endangers human beings. It deserves condemnation from every clinician who works on opioids, patient safety, pain & patient-centered care. thedailybeast.com/how-the-va-is-…
2/I disavow speaking for any agency. But I do speak for myself, and peers who have dedicated their lives to improving patient safety, as reflected in peer-reviewed lit I will cite. With Jeffrey Samet, who directs one node of the NIH HEAL initiative: jamanetwork.com/journals/jaman…
1/In 2007, after a wave of >1000 fentanyl overdose deaths, I wrote that the fundamental barrier to saving lives was a reluctance to “speak with outrage, and with love, about the lives that have been lost”
2/I am asking seriously. My thought had been “if we speak now and say these lives matter to us, we will do everything in our power to save them”.
What is the lesson of the last five years? Have our actions been insufficient? Many state policies: jamanetwork.com/journals/jaman…
3/That last paper suggests the success of prescription opioid control just pushed the number of deaths ⬆️ as people with opioid use disorder shifted toward more lethal product. But such state level models are never free of fault.
1/The message from @AmerMedicalAssn to “Stop Scope Creep” flags a signal in opposition to the lessons I gained from 24 years of care for persons experiencing homelessness.
2/I can imagine some specific tensions that do arise for generalist MDs like me if payers supplant us fully in favor of other clinicians - but a broadcast hashtag #StopScopeCreep runs smack into many other competing and serious problems
3/First: in my world of caring for persons experiencing homelessness, I have been teamed up with Nurse Practitioners and Physician Assistants and RNs whose training and life experience are absolutely crucial, and compensate for my limitations
2/Interviews with 41 persons tapered (⬇️>50% ) were open. The framework for assessing stigma allowed that it may include “societal-level conditions, cultural norms, & institutional policies that constrain the opportunities, resources, and wellbeing of the stigmatized”
3/Major finding: "Participants identified themselves as overlooked and negatively impacted by measures implemented during the pharmacovigilance period, including various tapering initiatives"
Yep, I've witnessed that.
1/I'm excited that Dr. @AjayManhapra is presenting on concerns about mandatory opioid taper for VA's MAT-VA journal club, based on our shared paper... he notes Human costs of mandatory and widespread opioid taper
2/He cites @BethDarnall as the best available study, noting that even when one offers the best support system, a significant % of patients do not have a reduction in pain or pain worsens.
3/In a way that will seem controversial, he proposes that opioid therapy is not exactly an analgesic. This is daily use of an addictive substance that offers relief, where only a minority develop addiction.
1/Nice viewpoint out today: "Balancing the Risks and Benefits of Benzodiazepines" -authors note risks of these drugs and their utility, in light of @US_FDA changing the label to highlight risks jamanetwork.com/journals/jama/…
2/FDA's revised warning will more thoroughly cover risks, and the authors endorse that "increased caution regarding benzodiazepine use is warranted; fewer benzodiazepine prescriptions are needed" ... with a careful stipulation...
3/Benzodiazepine risks needed to be highlighted, "However, when considered without an appropriate patient-centered context, this enhanced warning statement might lead to fewer appropriate prescriptions and unintended consequences" - this should echo what happened with opioids