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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More from @StefanKertesz

5 Oct
1/An excellent new article reviews this summer’s controversial pushback against efforts to remediate the antisemitic mistreatment of Mountain Brook Jewish youth, by other youth. I will share some comments as a regional resident too atlantajewishtimes.com/adl-embroiled-…
2/First, antisemitic comments or mistreatment of Jewish students in suburbs south of Birmingham is the “modal experience”, ie most Jewish students hear comments denigrating their religion, from peers. This doesn’t mean most non-Jewish students say such things or harbor such views
3/I base my statement that it is the “modal” experience from talking with Jewish youth who grew up here and with their parents and confirming with multiple Rabbis. And *none of this is unique to Mountain Brook* - it typifies *all the bourgeois suburbs south of Birmingham*
Read 17 tweets
4 Oct
1/Preventing evictions saved lives during this pandemic writes Matt Desmond (aka @just_shelter) in this new piece - one key problem is we haven't acted to deal with the prepandemic situation. Normally, we have 7 eviction filings per minute nytimes.com/2021/09/30/opi…
2/The national eviction moratorium lasted 331 days, averting 1.6m evictions, reducing pandemic deaths by 11%. Southeastern states, where evictions are⬆️& vaccinations⬇️have not robustly acted to limit evictions, he writes
3/Small landlords have lost real money. However foreclosures on their properties are ⬇️78% vs prepandemic era, due to a moratorium on foreclosures. The $47bn Congress allocated to protect tenants & landlords has been very slow in distribution...
Read 8 tweets
25 Sep
1/This week I received reports of several deaths after forced opioid taper, including a CSI:OPIOIDs collaborator.For that, there are no words

Our @OnHealer episode on Forced Taper touches on a way forward, based on genuine respect for patients pod.link/healer/episode…
2/For my peers, let’s acknowledge: (a) there are patients for whom taper is helpful, (b)retrospective database studies showing harm (or lack of harm) don’t permit strong, uniform conclusions

(c) in medicine, we normally don’t force change on stable patients absent consent ☑️
3/But in practical reality, the policies and metrics that tend to incentivize or mandate forcible taper of stable patients lack credible evidence in their favor, and at this time they run contrary to 3 separate federal declarations from: FDA, CDC, HHS, all in 2019.
Read 14 tweets
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
19 Aug
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/…
Read 5 tweets

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