Thread by @StefanKertesz

The next CDC Opioid Guideline draft is coming:

Be ready to speak LOUDLY to protect patients who were *not protected* by institutions that gave that the 2016 Guideline regulatory force, without regard to the the complexities of scientific evidence

https://twitter.com/speakingabtpain/status/1486421616015945735

2/My 2016 comment to CDC anticipated such harm:

“As medical boards, insurers and government agencies enforce this guideline, prescribing differently from the topline recommendations is likely to become onerous, leaving many patients in the lurch”

stefankertesz.medium.com/considering-cd…

3/Many of us didn’t fully anticipate that patients would be abandoned,

Or that DEA would use that threshold to investigate doctors,(and to seek criminal convictions)

But I now have observed that is the reality

4/By 2019, the CDC agreed their Guideline was misapplied.. they came to that understanding partly as a result of countless protests by patients themselces, and efforts by people like @BethDarnall @speakingabtpain @slsatel @AJ_Gordon

cdc.gov/media/releases…

5/The prescription reductions achieved to date began *before the CDC Guideline*, and they accelerated after. We are now at the level of 1993.

6/One can suggest that this massive reduction did contribute to a steep fall in misuse of prescription-type opioids by youth.

7/However the expected reduction in mortality from drug poisoning did not materialize. It seems more likely than not, to me, that our Rx reduction contributed to the illicit market’s traction.

The overdose toll rose

washingtonpost.com/health/2021/11…

8/The reality is:

*protecting and helping* people, is

-NOT defined by making Rx pills go ⬆️ (as pharma argued up till 2017)

-NOT defined by making Rx pills go ⬇️

We *always* needed to measure the opioid crisis differently

9/There is reason for hope, beginning with the fact that scientific evidence has justified the concerns we expressed,

and that the CDC received thoughtful criticism on a preliminary draft of its Guideline cdc.gov/injury/pdfs/bs…

10/Were it up to me, the coming Guideline would not be about “opioids”, as if those pills are our primary obligation

The Guideline I wish for would be about helping people with long term pain, and (often) difficult challenges & contexts

But that is not where we are.

11/As things stand we must wait for the draft

Then comment with focus on science but also on ethics.

To discount patients “left in the lurch” (as I wrote 5 years ago) was an ethical failure, not a scientific one.

We must make it *unacceptable* to fail in this way again/fin

This thread may be of interest to @AJ_Gordon @slsatel @PainPtFightBack @OregonAdvocate @ArtL7 @LeoBeletsky @BethDarnall @nabarund @papergirlmacy @speakingabtpain @maiasz @PoojaLagisetty @DrPoorman @DrScottHadland @DrSarahWakeman @CDCgov @national_pain @AllysonVarley and more