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. @NBCJoshua Illegal, not medical, #opioid use fuels ODs, which have risen exponentially since at least 1979, predating more liberal prescribing patterns. Addiction & use aren't rising: people are taking increasingly lethal drugs & combinations of drugs. /thread
. @TheWeekMSNBC "Overprescription" isn't "fueling the OD crisis." @AmericanCancer says #addiction in medical use is "very rare." #CDC Guideline is based on an average 96% unremarkable use; 4% includes nonaddictive misuse & long use. Large studies put addiction rate under 1%. 2/
Canada's Guideline: 96.7% unremarkable use; 3.3% includes nonaddictive misuse & abuse, in keeping w/ #CDC's Guideline. Brat et al. found a 99.4% rate of unremarkable use in more than 1 million post-op opioid scripts. 0.6% included people who refilled their scripts (BMJ 2018). 3/
Ciesielski et al. found a rate of 99.7% non-addictive use & identified readily available information that can be used to predict the likelihood of abuse (American Journal of Med 2016). (Direct links at end of thread.) 4/
By its own admission, #CDC never had solid evidence that reducing prescription #opioids would reduce ODs. See Guideline Table 1: Grading of evidence. Read the column "Limitations." 5/ https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fmmwr%2Fvolumes%2F65%2Frr%2Frr6501e1er.htm#T1_down
By 2017, #CDC admitted that "declines in #opioid prescribing metrics ... have not been followed by decreases in opioid overdoses. Instead, #overdoses due to illegal opioids (heroin, illicitly manufactured fentanyl) have increased" (Bohnert et al 2018). 6/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6176709/
In the 2018 study linked above, #CDC researchers identified OD as the outcome “of greatest interest to public health." You'll find their admission that reductions in #opioid scripts were followed by increases in ODs at the end of the 8th paragraph in the Discussion. 7/
0.1 to 0.2%: Multiple studies & national guidelines find the same risk of OD to prescribed #opioids: one-tenth to two-tenths of 1% (Canada 2017).
300% = Increased risk of OD from dose variability of 30%, which is common in tapers & forced discontinuation (Glanz, JAMA 2019).
300% = Increased risk of OD from dose variability of 30%, which is common in tapers & forced discontinuation (Glanz, JAMA 2019).
2,887 #vets died of OD or suicide after their #opioid medicine was stopped in FY2013. That's only 90 fewer deaths than on 9/11. Discontinuation puts people at up to 6.8 times increased risk of death compared to continuing treatment (Oliva et al BMJ 2020). https://www.bmj.com/content/368/bmj.m283.long
Of course, #opioid prescription restrictions don't just kill people. They also disable them unnecessarily and/or cause them to terminate all medical care.
Perez et al. Journal of General Internal Med. 2020 Jan 1;35(1):36-42. https://link.springer.com/article/10.1007/s11606-019-05227-9
Perez et al. Journal of General Internal Med. 2020 Jan 1;35(1):36-42. https://link.springer.com/article/10.1007/s11606-019-05227-9
Rx #opioid limits don't protect people w/ #addiction from OD to illegal drugs, & they increase OD & suicide in people w/ #pain. Doctors should determine risk/benefit for individuals. Lawmakers & insurers should let them do their jobs. Factsheet: https://docs.google.com/document/d/e/2PACX-1vSfZnX-PaQh_cJLQC_RgNjxm0T7EgzaxGlTg36LxVtjnRWp3uv8IDjSBqQt1sTt8OquDd7R6k5-KCj_/pub
-Rx OD 0.1-0.2%: Canada Rx #Opioid Guideline (2017) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5422149/
-99.4% addiction rate: Brat et al. Post-Op #Opioid Rx & Misuse. BMJ. 2018 Jan 17;360:j5790. https://www.bmj.com/content/bmj/360/bmj.j5790.full.pdf
-99.4% addiction rate: Brat et al. Post-Op #Opioid Rx & Misuse. BMJ. 2018 Jan 17;360:j5790. https://www.bmj.com/content/bmj/360/bmj.j5790.full.pdf
-Rx #addiction 99.7%: Ciesielski et al. De Novo #Opioid Abuse. American Journal of Medicine. 2016 Jul 1;129(7):699-705. https://www.amjmed.com/article/S0002-9343(16)30202-9/fulltext
-Glanz et al. Dose Variability & OD. JAMA Network Open. 2019;2(4):e192613. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2730786
-Glanz et al. Dose Variability & OD. JAMA Network Open. 2019;2(4):e192613. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2730786
Thanks to @NBCJoshua for noting that #ChronicPain patients have a "legitimate need" for rx #opiods. If @TheWeekMSNBC would cover the story from the perspective of people w/ #pain, we'll happily provide contacts for interviews & additional info. See thread above-- @JillPiggott
