1/FYI:Opioid Rx’s 60% vs 9 years ago.

Outcomes have not been good. OD deaths are way , & patients traumatized

This thread covers 4 years of my peer-reviewed articles.

Let’s recalibrate policy, measure what we are doing, and LISTEN to the folks whose lives are at stake https://twitter.com/johannhari101/status/1344402937121009664

2/This is the overall policy review of how we got here and how we mis-allocated the response (with @AJ_Gordon) ,

and why policy winds up (inevitably) being less than rational in the real world @AddictionJrnl https://onlinelibrary.wiley.com/doi/abs/10.1111/add.14394

3/This piece says why efforts to “Turn the Tide” with a narrow focus on Rx risked a Riptide for patients, as fentanyl deaths rose.

The article led me to brief then Surgeon General @vivek_murthy in 2017- who shared this concern completely https://www.tandfonline.com/doi/full/10.1080/08897077.2016.1261070

4/Here in @JAMANetworkOpen with Dr Jeffrey Samet in 2018, we discuss “Directions & Misdirections” in opioid policy - the need is for treatment expansion & education. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2682874

5/Here 3 clinician-researcher declare that that prescriptionsare a “solemn responsibility”

But we saw no evidence that legal restrictions on duration will substantially alter the prevalence of addiction, @MMundkur @AJ_Gordon https://www.tandfonline.com/doi/full/10.1080/08897077.2017.1345194

6/The presence of prescribed opioids in decedents is a reminder that they still do matter, however, I wrote with @DrScottHadland in @bmj_latest based on work by @Tara_Gomes

And the policy response requires a broader approach https://www.bmj.com/content/362/bmj.k3537

7/This 2019 editorial in @ASAMorg Journal of Addiction Med delivers a simple plea: that we start measuring the outcomes of prescription policies https://www.journalofsubstanceabusetreatment.com/article/S0740-5472(19)30280-6/fulltext

8/One reason for concern was this: observational followup data where overdose and suicide were higher in persons who had opioid discontinuation. It is not proof of cause & effect but it sends a signal of concern. https://www.bmj.com/content/368/bmj.m283

9/By 2020, we urged that mandates to taper #opioids were not justified ethically or clinically -
even when there could be debate about the original initiation of those meds.
Clinical complexity shouldn’t eclipse moral clarity https://journals.sagepub.com/doi/full/10.1177/1073110520935337

10/For anyone (a) planning new policies or (b) researching the IMPLEMENTATION of opioid prescribing changes, please use our blueprint to promote patient-centered approaches to action and assessment - @JournalGIM @BethDarnall @AllysonVarley https://link.springer.com/article/10.1007/s11606-020-06254-7

11/There are many other writers & speakers I recommend on #opioidcrisis @maiasz @slsatel @AJ_Gordon @CarlynZwaren @KeithNHumphreys @crackdownpod @DrSarahWakeman @headdock @BobTwillman @speakingabtpain @LeoBeletsky @DrEllenEaton @adfurlan - please engage even if you do disagree

12/For those of us who don’t like where we are headed so far in responding to a tragedy that involves pain, addiction & profound stigma, those 9 articles reflect my best effort, always with cherished collaborators, to redirect and help us revise with #evidence #science #mercy