1/Prescription opioid counts have fallen to levels last seen in 1992,reports @US_FDA Corinne Woods, PharmD for workshop at Duke Margolis today
2/Prescription #opioid milligrams are at levels of early 2000s. That number is higher (relative to prescription count) according to @US_FDA Corinne Woods, PharmD at Duke-Margolis today - I think this difference reflects the patients with long term receipt.
3/Total milligrams and total count of oral tablets in an “initial prescription” have declined, reports @US_FDA Corinne Woods, PharmD to today’s session for Duke-Margolis and FDA (2 images here)
4/Opioid prescriptions to children have declined a good deal. Note this breaks our prescribers by specialty and that the x-axis is not the same in the two images (left vs right) reports @US_FDA Corinne Woods, PharmD at today’s session for Duke-Margolis
5/When buprenorphine is started for treatment of Opioid Use Disorder, it is now increasingly a treatment started in primary care. And nurse practitioners are playing a rising role. Report from @US_FDA Corinne Woods, PharmD
6/Summary points from @US_FDA - notes large ⬇️ in prescription, less of a decrease in MME, decline in overlap of benzodiazepine & opioids, and fewer patients starting (wait for final observations next!)
7/In the additional points, @US_FDA speaker notes that high level data is limited, that ⬆️Rx prescribing played a role in opioid crisis and acknowledges unintended consequences from reductions - thank you Corinne Woods, PharmD /fin
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🧵1/Our @uabmedicine Grand Rounds will feature a diagnostic showdown between Dr Martin Rodriguez and ChatGPT4
I am scared here because I don’t want AI to win
2/the case features behavioral changes, swearing, cognitive decline, cough, progressive weakness over 3 years.
I wonder about infectious and rheumatic disorders. Maybe primary neurological
Aspirations after a cognitive change is possible
Dr Rodriguez opens. Not much to go on.
3/ChatGPT generated a lot of text read by Dr Kraemer but it is pretty good, with emphasis on neurological disorders followed by a disclaimer “please note that this does not substitute for professional medical advice”. Both want more information
Truth💣 1/ The “NARXCare” opioid Rx risk algorithm is in all Prescription Monitoring Databases,ie ~1 bn Rx’s/year
NOW in @JournalGIM
✅evidence does not yet exist to support it as safe or protective
✅It has flourished due to lack of federal oversight link.springer.com/article/10.100…
2/The authors, led by Dr Michele Buonara, review the core argument as one in which this algorithm with low evidence to its favor
and high risk of harm
has gone unregulated
despite apparently fulfilling @US_FDA criteria that mandate it be regulated
3/Nearly all prescribers and national pharmacies now see the Bamboo Health, Inc proprietary “NARXcare” algorithm in a more prominent position *than the prescription history itself” when they view a prescription history.
1/Arguing for methadone deregulation, Dr. Ruth Potee notes that in an auditorium of 400 addiction specialists, almost NONE prescribe methadone (because they can't)
"Methadone is a miracle drug that no one has access to"
There are more people who offer Botox than offer methadone
Patient: “I can still do my activities”.
Doc: "No way, not really. I read the SPACE trial, and there is NO benefit (that would outweigh the opioids’ risk)”
"Shared decision-making" seems *doomed* here
1/I watch with concern as DEA prosecutions of MDs still seem to rely on “they prescribed more than I would” despite a 9-0 ruling of
Supreme Court last year
Sudden termination of opioids & progressive abandonment of 5-8 million patients is dangerous
1/Even on inpatient rounds, it is possible to introduce the idea that addiction isn’t (only) in the brain.
I contrast @NIAAAnews “brain disease” against a behavioral economics vide substance use as a pattern of behavior occurring in relation to environmental context
2/On teaching rounds we read aloud and discussed the @NIAAAnews brain-science model of addiction, pulling just a few lines off their website
3/then we read lines from Chapter 39 of “Evaluating the Brain Disease Model of Addiction” - this presents harmful substance use as a pattern of behavior based on assessment of competing rewards, delay or uncertainty of desired rewards, risks and costs - ie behavioral economics