Thread by @ravensspirit68

1-Tx of pain & the role of opiate class medicines has gone from pain being inadequately treated across the board to abject insanity.
This was done in an orchestrated but convoluted way, taking pain and making it a 'bio-psycho-social' issue tied inexorably with addiction.

2-For those unfamiliar with CHOIR, it's one of Stanford's projects. It was promoted with the National Pain Strategy (when it was a thing) alongside PROPs opioid 'guideline' as a model for technology driven optimization of pain care through research and data mining.

3-The screenshot above in tweet #2 is from this link. iprcc.nih.gov/sites/default/…

4-Looking at a snapshot of CHOIR in practice-
This is the type of data that now plays a primary role in deciding basically what type of treatment a pain patient will or will not receive based on risk assessment.
The higher the 'risk' the less chance opiates will be recommended.

5-Link to above screenshot. All about CHOIR.
Please take a look around.
choir.stanford.edu/clinical-pract…

6-Another snapshot on CHOIR and pt 'scoring' process.
"CHOIR displays the factors that have been found in the literature to be a predictor of outcome after procedures or surgeries. These include Substance Use, Adverse Childhood Experiences..."
'Outcome' like risk of addiction.

7-Anyhoo, basically there are systems in place now being implemented that use 'pain perception' as well as a psycho/social profile to determine your 'risk' & decide proper treatment based on said 'risk'.
Fundamentally the 'risk' of you taking opioids due to the 'opioidcrisis'.😔

8-In other words, "PREDICTIVE MODELING'.
Like the role and service of the pre-cogs in Minority Report. They base your future probability of action on your past through a scoring system.
Not because you've done anything 'aberrant' or have issues w/addiction but because you MIGHT.

9-NARXSCORE system of APPRISS ('Bamboo Health) is yet another tool along these lines. This system, as of today, is being tied into the PDMP, at least here in California. Yet another data mining tool for 'risk assessment' & 'predictive modeling' to determine what's right for you.

10-Another feature of APPRISS' system is the data mining on MDs 'prescribing habits'.
The 'opioid RXing report card' referenced in that NEW YORK meeting I linked yesterday. A meeting with ideas heavily influenced by none other than Andrew Kolodny, Addiction Psychiatrist.🤔

11-Billions of $ later we come full circle back to pre-PROP guideline agendas resulting in what we're facing today.
Pain being inadequately treated across the board for those w/chronic pain and ODs continuing to skyrocket.
Because this was NEVER really about RX opiates at all. 😔

12-This was a very inadequate overview of a very complex and convoluted process that's been in the works since the early 2000s. Siobhan Reynolds sounded the alarm, but no one was listening.
It's time people wake up. We need to put a stop to this madness.

I did want to add, the pilot programs conducted through Kasier Permanente and the VA are not just conjecture, on my part, it happened, and is still happening.
This is PRE cdc 'guideline' info. chcf.org/opioid-safety-…

I will say too that IMO the 'National Pain Strategy' per se is sort of irrelevant at this point, though important to note that NPS objectives were absorbed into different applications of 'opioid response' applications & are being achieved through other programs/practice/policy.

*strike the second word 'applications' in above tweet. 🙄 #Twitedit