(1/9) Mini 🧵on the amicus brief filed by @national_pain around physician liability for dispensing Rx drugs under the Controlled Substances Act.
Encourage y'all to read their thread & amicus if you have time, but wanted to talk about the chilling effect of federal opioid policy.
Encourage y'all to read their thread & amicus if you have time, but wanted to talk about the chilling effect of federal opioid policy.
https://twitter.com/national_pain/status/1475507669502939139
(2/9) In their amicus brief. @national_pain talks about the "chilling effect" of the CDC's harmful, albeit most likely well intentioned, 2016 Guideline for Prescribing Opioids for Chronic Pain & the sharp decline in opioid prescribing we have seen since: cdc.gov/mmwr/volumes/6…
(3/9) The amicus succinctly lays out the cascading impact of this document & federal policy more broadly on preventing physicians from acting in the best interest of their clients out of fear of scrutiny & censure from the government.
Bad guidance became a worse mandate.
Bad guidance became a worse mandate.
(4/9) Rx opioid use is down 60% from it's peak in 2011, with the sharpest declines coming after 2016 when the CDC guidelines on opioid prescribing were released.
Rx opioid use is the lowest it's been for 2 decades. And yet, more people are dying of overdose than ever before.
Rx opioid use is the lowest it's been for 2 decades. And yet, more people are dying of overdose than ever before.
(5/9) Between April 2020 & April 2021, more than 100,000 Americans died of drug overdose. Of that number, 64% of deaths involved synthetic opioids, chiefly illicitly manufactured fentanyl.
More people OD'ed & died on fentanyl in that time than were killed by ALL drugs in 2015.
More people OD'ed & died on fentanyl in that time than were killed by ALL drugs in 2015.
(6/9) 2015. The year OD deaths were so shocking the CDC released new guidelines aggressively dissuading physicians from prescribing opioids.
With a big assist from law enforcement, their plan worked. Fewer people used Rx opioids.
But more people died & were in untreated pain.
With a big assist from law enforcement, their plan worked. Fewer people used Rx opioids.
But more people died & were in untreated pain.
(7/9) This is when we return to the chilling effect.
The federal government does not have to pass legislation or create new regulations to have profound effects on societal behavior & health outcomes.
Merely the threat of censure or penalty is often enough, as it was here.
The federal government does not have to pass legislation or create new regulations to have profound effects on societal behavior & health outcomes.
Merely the threat of censure or penalty is often enough, as it was here.
(8/9) In response to an unprecedented Rx opioid epidemic, federal officials created guidance & began interpreting laws to stop Rx opioid deaths, but they did not stop long enough to think of where those folks who were using Rx opioids would go when they were taken away.
(9/9) We are in an environment where a doctor who wants to prescribe an opioid to treat acute or chronic pain does not do so out of fear of investigation.
It is a toxic environment. For physicians, for patients, for people who use drugs, & for society in general. #HarmReduction
It is a toxic environment. For physicians, for patients, for people who use drugs, & for society in general. #HarmReduction
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