1: Before sharing our *New* research on homelessness, I want to share my *First* effort - 37 years ago, as a high school senior, street interviews & moral reflection for the Homestead @epitaphHHS 🧵
2/Street interviews led me to think we are all dealt a hand of cards…

“Society as it is doesn’t really allow for the people who are dealt bad cards. We would prefer to see them dwindle away when what we really need is perhaps to give them a second chance at the deck” -1984
3/Out now in @AmJPrevMed “Unsheltered Homelessness reflects a Stack of Personal and Community risk factors among veterans” uab.edu/news/research/…
5/it is rare to compare my take on a subject from age 17 to now. The evidence & data evolved butmy moral perspective did not.

May be of interest to fellow Epitapher @shearm &
@UABNews @vahsrd @SocietyGIM @DeborahPadgett5 @@hardlynormal @homeless_new @cappi_uab @naehomelessness

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More from @StefanKertesz

10 Sep
@conor64 @cultofphil @rhett_orackle @KennyGIsCool @benshapiro 1/It's not easy to model because of many differences and probably a significant number of unmeasurable. But one thing to take some measure of the actual risks of drunk driving. One estimate is that every drunk driving trip has a 1/625 risk of crash. ncbi.nlm.nih.gov/pmc/articles/P…
@conor64 @cultofphil @rhett_orackle @KennyGIsCool @benshapiro 2/Most crashes don't involve loss of life. Among about 6m car crashes a year, only 36,000 people died in 2019, ie 6 deaths per 1000 crashes. So if you drive drunk 625000 times, crudely, there are 6 deaths (lower bound, due to assumptions)
@conor64 @cultofphil @rhett_orackle @KennyGIsCool @benshapiro 3/It's reasonable to guesstimate that "drunk crashes are more lethal crashes"(someone has studied this; not me).. So let's assume a person who drives drunk 100000 times causes 10 deaths. But we know that's not the real math because no single person drives drunk 100k times a year
Read 19 tweets
8 Sep
1/New study in @DrugAlcoholDep finds that a national Stay-at-Home order for COVID-19 had "variable" impacts on opioid OD-

And it demonstrates that Emergency Dept overdose diagnoses deliver only a very cloudy view on overdose rates, - KY, OH, MA, NY sciencedirect.com/science/articl…! Image
2/ 3 of 4 states (MA,NY,OH,*not KY*) had a 10 week ⬇️ in ED visits for opioid OD after pandemic hit.
Then, ED visits ⬆️ for MA,OH,KY
**But ED visits don't relate tightly to death**
OD deaths for 2020, relative to 2019:
MA:⬆️2%
NY:⬆️34%
KY:⬆️54%
OH:⬆️22%
commonwealthfund.org/blog/2021/drug… Image
3/Authors conclude what I agree with, but I'll comment.
They say:
"results support our hypothesis of a significant impact of the national stay-at-home order on ED encounters for suspected OOD in the 4 HCS states, but indicate that the dynamics of this impact differed"

YES, and.
Read 7 tweets
18 Aug
1/There is new guidance to avert the transmission of #COVID19 among persons experiencing #homelessness from @USICHgov and it demands a halt to forced breakup of camps or forced hotel-to-shelter transfers for the vulnerable: usich.gov/news/usich-rel…
2/Many communities never had hotel rooms but those that did have been pushing individuals who are quite vulnerable into tight congregate shelters, even though there is money to cover cost of emergency accommodation (plenty) sfchronicle.com/sf/article/S-F…
3/Crucially @USICH says Vaccination should be encouraged, but not treated as prerequisite to housing
(CDC: no single “preferred” vax formulation, use flyers+text, mindful planning & reminders for 2-dose regimens).
Read 7 tweets
3 Aug
1/A new JAMA paper by @AliciaAgnoli & @fenton_jj finds #opioid taper associated with ⬆️risk of overdose & mental health crises in patients previously on higher opioid doses. I’ll offer context, summarize findings, and review implications. Here goes. jamanetwork.com/journals/jama/…
2/Context: prior data showed ODs more likely in patients with higher Rx’d dose, which *couldn’t prove* cause & effect. MDs had historically ⬆️’d dose in patients who had other risks. One can argue that ⬆️doses
*ADDED risk,
*or were MARKERS of risk:
jamanetwork.com/journals/jama/…
3/An example: I had a case where the prior MD ⬆️’d opioid dose for a long-term patient who reported ⬆️pain. But that pt had long-term psych diagnoses, and pain ⬆️ *right after his son died* Thus, the dose ⬆️was a marker for emotional risk factors, AND (b) dose may have added risk
Read 26 tweets
7 Jul
1/In March, @SZKamal and I wrote that the single biggest challenge to averting an #eviction crisis was rapid deployment of the aid appropriated by Congress - today’s @washingtonpost finds the same problem 4 months later washingtonpost.com/business/2021/…
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
Read 6 tweets
5 Jun
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…
3/Promoting Patient-Centeredness in Opioid Deprescribing: a Blueprint for De-implementation Science, written with
@BethDarnall @AllysonVarley Megan McCullough :link.springer.com/article/10.100…
Read 8 tweets

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