The @CDCgov implementation materials look pretty good.

Below -- what the Guideline IS intended to be...

cdc.gov/opioids/health… What Guideline is NOT

Final thoughts. Still need to read through their implementation materials - hopefully they focus on individualization.
But to continue, my last overarching concern is that, like the proposed GL, the final is MUCH BROADER, covering acute, subacute and chronic pain. 22/ In theory, this is fine, there is no reason to single out chronic pain and prescribing for acute pain seemed more associated with diversion of pills but 23/

🧵continues from earlier with early impressions of the 2022 CDC Guideline - now the concerns.

The GOOD - as proposed, they finalized removal of the thresholds that caused the biggest problems from 2016 - day and dose thresholds - from the main recommendations. Yay!

But...
16/ They continue to overly rely on MMEs - or morphine milligram equivalents - throughout the text.

50 MME appears 23X

Each time, they qualify it, and say it shouldn't be applied as an absolute threshold, that people need different things, etc.

So what's the problem?
17/

1st impressions of the just-released final 2022 CDC Guideline. The good, the bad, and post-Halloween, the haunting 👻skeleton of 2016 that remains.

A 🧵. cdc.gov/mmwr/volumes/7…
1/ First, background. The 2016 was widely misapplied in ways that harmed patients (as CDC acknowledged in 2019) 2/

1/ The newest survey of Drug Use and Health for 2020 has doubled the number with some sort of substance use disorder from 20 to 40 million people.

This is partly from changes in terminology and methodologies.

medpagetoday.com/psychiatry/add… 2/ The survey also found that 53 million have with some mental illness and 19 million have severe mental illness
50 M daily pain (100 M some long term pain); 20 M severe/ high impact

(Includes tobacco)

1/ A very compelling story about how #Women's #Pain & especially #Black women's pain is dismissed and disregarded by the healthcare system.

today.com/health/implici… 2/ The story begins with a woman with sickle cell & her horrifying experience in the hospital. It also discusses pain from syndrome's unique to women, like endometriosis or fibroids.

HUGELY IMPORTANT resolution by @HHSgov prohibiting discrimination on the basis of #Disability in #MedicalRationing.

This - with TN - is the 4th such resolution & is the most sweeping and comprehensive.

hhs.gov/about/news/202… 1/ It Prohibits discrimination on the basis of disability- or age- related resource-intensity and duration of need, protecting people who need more treatment resources due to their age or disability from automatically being given a lower priority to receive life-saving care;

Recent study linking commonly prescribed non-opioid alternatives (gabapentin and balcofen) to increase in #suicide attempts in chronic pain patients #SuicideRisk #ChronicPain newsweek.com/opioid-replace… Over the period the drugs were studied, suicides attempts after people took just gabapentin rose by 80.5 percent, and by 43 percent for baclofen. The study found that use of these medications increased by 64% between 2012 and 2016.

👉👉👉VICTORY AT LAST IN OREGON ON FORCED TAPERING. Today, Oregon voted against a proposal to mandate tapering to 0 of Oregon Medicaid patients who currently take #opioids long term to manage #pain - an action that would, by Oregon’s estimation, have affected 60-100,000 people oregon.gov/oha/ERD/Pages/…. The proposal garnered national attention & the concern of over a hundred experts in pain medicine, addiction, and health policy. In light of their efforts and the growing evidence about the dangers of mandatory tapering, Oregon today demurred. 2/

🚨🚨🚨ATTENTION #Spoonies #ChronicPain community, people have been asking for the recent clarifications from the @CDCgov and the @US_FDA to take to their #Doctors, so I have created a pinned tweet with everything. #Opioids 🚨🚨🚨 👉👉👉The @CDCgov clarification appears in an article in @NEJM here nejm.org/doi/full/10.10…
👉👉👉with an accompanying press release: cdc.gov/media/releases…

The misapplication of the CDC guidance as strict laws and enforceable mandates is indiscriminate and is harming pain patients - the report questions this - opioids are also essential medications.

https://twitter.com/NatlAssnAttysGn/status/1112720124019204101

If you need some evidence - see the recent letter sent by three former drug czars and medical experts, covered in the @nytimes and @rollingstone and elsewhere

🚨🚨🚨Vulnerable tweet/thread alert. 🚨🚨🚨

Over the coming weeks, I am going to start a series of tweets & even act like a millennial and hashtag them as #Mythbusters #paintoo #painsplaining #painstigma and #painshaming. Today is vulnerable part - why I think this is necessary.

I’ve been public that I used opioids after a surgical injury to my spinal cord left me unable to sit or stand and severely limited in walking. #paintoo #painsplaining #painstigma #painshaming

2/

The carrot (financial incentives) and the stick (new legal mandates) are aligned in a full-throttled assault on opioid prescribing, which fell 74.4% according to the CDC betw. 2015). # of prescriptions filled at retail pharmacies is already at a 15-year low.

https://twitter.com/Peter_Grinspoon/status/1109238113698807809

Laws in half the states, proposed federal legislation, pharmacy and insurer mandates (which are financially incentivized with compensation packages to lower opioid use) place one-size-fits-all limits on the number of days or dosage at which opioids can be prescribed.

@andrewkolodny called our article (with Diane Hoffman & @ChadDKollas in @statnews on the harm to patients who legitimately use opioids for pain in the current regulatory environment, which begins with the AMA’s recent action stating the same, dishonest. statnews.com/2018/12/06/ove… 1/While the subject of opioids inspires polarizing and often simplistic or even eviscerating attacks, we need to welcome questioning and different perspectives in open debate, so here are his points and our response: