1/Shortly after DEA revoked the certificate of the doc who cared for Danny & his wife, both died by suicide, this month

I had sought help for Danny in 2018, when he lost a prior doc, writing he would likely die by suicide if no help was found

The Vice team went to the funeral
2/I told Vice that I can’t find anyone who believes all these patients should die,

Thus, I can’t understand why agencies act in a way that massively increases the likelihood of that outcome (even if you believe the doc was doing something wrong) "Even if you believe the doctors did something wrong, I
3/The CDC set up a program (ORRP) that is cited by DEA & CDC as protecting patients, but in reality, it is not designed or empowered to offer individual help.

Patients received a flier listing ER’s in LA, which we all know would not be able to help Rubel, in a statement sent via the CDC's press office, said
4/I had feared for Danny’s life as early as 2018 when I spoke to him, and wrote to colleagues around the country after his prior doc was shut down.

To @keegan_hamilton i said “Honestly, it seems to me like bombing a village”
5/Our ongoing research study to recruit survivors who have lost someone to suicide after prescription opioid discontinuation is #CSIOPIOIDS.

The entry survey is accessible at go.UAB.edu/csiopioids
Details are reviewed in my pinned tweet

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More from @StefanKertesz

Nov 3
1/As I said to @NPR the new @CDCgov Guideline on opioids is better, and I also disagree with key parts

But the #1 point:

protection for patients with long-term pain depends on 3 agencies NOW taking action:
@CMSGov @DEAHQ (DEA) and @NCQA
2/The CDC's revised Guideline says - commendably- NOT to use doses caution points to set rigid performance incentives on DOSE or DURATION

If taken seriously
then National Committee for Quality Assurance *must reverse* the High Dose Opioid Metric punishing docs for dose >90 MME
3/In 2017, @PQAAlliance urged @NCQA to adopt a metric counting the % of patients >90 mg as bad care. 80 experts begged NCQA not to, including 4 who worked directly on the 2016 Guideline
stefankertesz.medium.com/an-opioid-qual…
Read 21 tweets
Oct 27
1/Marijuana legalization in Uruguay 🇺🇾 was followed by a far smaller ⬆️ in use by teens & young adults, compared to Chile 🇨🇱 , where it was not.

The key may be in Uruguay’s approach, according to a new article in @AddictionJrnl onlinelibrary.wiley.com/doi/abs/10.111…
2/The difference between Uruguay’s legalization and Colorado’s is night and day, according to the editorial by Dr Julia Dilley- only cannabis plant/flower is legal. No vapes or edibles!
3/adults 18 & older must register to use only one source of marijuana: a pharmacy (only 16 in the country), a social club, or growth at home.

Colorado has 550 retail sales outlets (pop. 5.7m)

Uruguay has 16 (pop. 3.5m)
Read 5 tweets
Oct 20
1/In response to this tweet, from a journalist alleging a “class divide with addicted homeless”, I will offer corrective facts

Among Americans entering treatment for opioid use disorder in the federal TEDS dataset, 12.5% were homeless.
2/There are many reasons to be concerned that addiction treatment of high quality is not sufficiently available to ALL Americans, especially in states that fail to invest in it, but treatment for addiction is used by many who experience homelessness: pubmed.ncbi.nlm.nih.gov/1772151/
3/In one of my papers we looked at people who used Boston detoxes; persons entering detox were just as likely to seek formal treatment thereafter whether they were homeless or not, although residential treatment was more common for homeless pubmed.ncbi.nlm.nih.gov/16501393/
Read 8 tweets
Oct 19
1/ a beautiful and serious reflection on a patient who doctors found “challenging” highlights the power of patients who insist on knowing and understanding and holding clinicians to account.

It also reminds me of key themes in our podcast On Becoming a Healer
2/“Sal” in this story has command of his illness and often tests his doctors, who then find him exhausting because he isn’t passive enough .. what many doctors are trained to do is objectify -
3/Author @zaberdasst - a physician- was taught to adopt “therapeutic distance” this often winds up often being less-than-therapeutic for patients, although it prevents potentially inappropriate boundary violations. However in the long run it is not nurturing for docs or patients
Read 6 tweets
Oct 18
🧵The headline from a new @NEJM trial was
colonoscopy did not reduce risks of colon cancer death. I believe that the study limitations stood in the way of seeing reality here. Let’s talk it through (thread): nejm.org/action/doLogou…
2/Prior data led us to think more limited sigmoidoscopy prevents colon cancer death.
A 2014 RCT of 100k 50-64 year olds had 78k controls and 20.6k screened (63% adherent).
At 11 years f/u, colorectal cancer death was 27% lower among the screened. jamanetwork.com/journals/jama/…
3.And In 3 of 4 large RCTs of sigmoidoscopy screening, the relative risk of death from colorectal cancer was lower (range in relative reduction 22-31%), although not in one other study. nejm.org/doi/full/10.10…
Read 25 tweets
Sep 19
1/Our study to examine suicides after Rx opioid reduction has been FUNDED
 
It’s called CSI:OPIOIDs-V
We’ll look at suicides in Veterans & non-Veterans
 
Our outcome target is to help clinicians & healthcare organizations act to prevent these deaths Image
2/We are compelled to study these suicides because
(a) they’re alarming, and
(b) they occur as part of health care changes justified as being “for safety”
3/Our team of suicide, opioid & pain scholars chose a unique approach for this study 📖:psychological autopsy.

I wish to explain why Image
Read 21 tweets

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