1/Bioethicist @TNREthx offers peer-reviewed paper #3 to find nonconsensual opioid tapering of stable patients unethical. (Links to other 2 below). This unethical practice is incentivized by: quality metrics, @CMSGov, SUPPORT Act,insurers & OIG for HHS-but data do *not* support it https://twitter.com/StefanKertesz/status/1289992482072064000

2/The paper I wrote with 2 other addiction doctors in Journal of Law, Medicine & Ethics "Nonconsensual
Dose Reduction Mandates are
Not Justified Clinically or Ethically": is summarized in this thread: https://twitter.com/StefanKertesz/status/1280996765798469632?s=20

3/The paper "Opioid Prescribing and the Ethical Duty to Do No Harm" by civil rights/disability attorney @speakingabtpain and legal scholar Deborah Hellman of @UVALaw https://journals.sagepub.com/doi/full/10.1177/0098858820933500

4/These concerns are now expressed distinctly and with somewhat different logic and rationale from a bioethicist, frontline doctors, and the legal profession. They matter because the agencies regulating US healthcare and health care quality have NOT adjusted policy, not at all.

5/Anyone who digs into my work SHOULD know my view: there are patients who are on long-term high dose opioids, who shouldn't have been dose-escalated originally, who MAY benefit from a downward transition, carefully negotiated and managed by experts

6/Anyone who digs into my writing or talks know I believe #opioids were massively over-prescribed, that doing so did harm, that dependence is often not benign, and that there is a reason to reduce opioid-reliance (which has happened) https://onlinelibrary.wiley.com/doi/full/10.1111/add.14996?af=R

7/Those realities named, the *core issue* is:

whether we as a society will court risk of harm to patients...in the name of making the number of opioid prescriptions go down, regardless of what happens to those patients

More than a few are now saying "no, that's wrong" /Fin

8/people who might be interested in this review: @AjayManhapra @AJ_Gordon @BethDarnall @speakingabtpain @CDCgov @NCQA @HHSGov @CarlynZwaren @crackdownpod @BrianMannADK @katiezez @LennyMBernstein @abbygoodnough @ClaudiaWallis1 @VICE @maiasz @ZachWritesStuff @LeoBeletsky @slsatel