Stefan Kertesz, MD, MSc @StefanKertesz Twitter profile | Pikagi

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Stefan Kertesz, MD, MSc

@StefanKertesz

15,416

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8,731

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5,061

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31,444

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Physician/research in primary care, homelessness, addiction. Professor, UAB nullius in verba

Birmingham, Alabama

https://t.co/9uPspC64H1

Joined January 2012

Don't wanna be here? Send us removal request.

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@StefanKertesz

Stefan Kertesz, MD, MSc

1 year

1/CSI:OPIOIDs is a research study to examine suicides that happen after prescription opioid dose reductions in patients with long-term pain, so that these losses can be prevented This is our study. This is our passion. This is us. #NoMoreSuicide

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Research to Understand and Prevent Loss of Life After Medication Dose Reduction in Pain

CSI:OPIOIDs is a research study to examine suicides that happen after prescription opioid dose reductions in patients with long-term pain. This is our study. This is our passion. This is us.

www.csiopioids.org

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@StefanKertesz

Stefan Kertesz, MD, MSc

4 months

@madelaine_lucas “Gainfully loved”

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@StefanKertesz

Stefan Kertesz, MD, MSc

1 year

I recently came across a psychiatrist who has a strict rule for “inherited patients” on multiple meds He *immediately stops, without taper* benzodiazepines for any patient also on buprenorphine A strict rule, wholly at odds with standard of care, and dangerous. WTF?

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@StefanKertesz

Stefan Kertesz, MD, MSc

4 years

@NPR @hereandnow I published in 2008 that Blacks & Lantinx in ED’s were less likely to receive opioids for almost every possible deeply painful condition including long bone fractures and kidney stones. I can’t believe WBUR’s celebration of such disparities.

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@StefanKertesz

Stefan Kertesz, MD, MSc

4 months

@jeffstorobinsky The English language dubbing is terrible. It was much more compelling in the original Hungarian.

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@StefanKertesz

Stefan Kertesz, MD, MSc

4 years

My 81 year old mom is in an ER I’m SC with a severe acute illness. My father, upon whom she is dependent to communicate for her, is forced outside. Without him, she can’t process the info. I am worried dependent elderly adults like my mom will not get appropriate care

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@StefanKertesz

Stefan Kertesz, MD, MSc

2 years

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

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@StefanKertesz

Stefan Kertesz, MD, MSc

1 year

1/This week two stunning reports from @nytimes & @VICENews document a trail of trauma to pain patients following law actions focused on opioid-prescribing physicians- Strong reports from both @keegan_hamilton & @maiasz -

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@StefanKertesz

Stefan Kertesz, MD, MSc

4 years

Many hope that stopping prescription #opioids makes risks go down. Our study of over 1 million patients finds risks of suicide AND overdose go UP. Prescription stoppage doesn’t create safety. ⁩

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@StefanKertesz

Stefan Kertesz, MD, MSc

5 years

@KeithJGamble Please tell your daughter that my father went to a German concentration camp at age 9, partly because people just stood by &watched. He survived. And he would be thankful that your daughter stood up for what is right. Institutions sometimes don’t hear right and wrong, at first.

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@StefanKertesz

Stefan Kertesz, MD, MSc

1 year

US laws make it a crime for me, an addiction medicine doctor, from prescribing methadone in my office to stabilize a patient with opioid use disorder These laws assure the deaths of patients who need not die Congress must pass S. 644/H.R. 1359 @ASAMorg

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Addiction Doc Urges Lawmakers to Rethink Methadone Prescribing Restrictions

Suicide prevention in traumatic brain injury survivors also on the docket during hearing

www.medpagetoday.com

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@StefanKertesz

Stefan Kertesz, MD, MSc

2 years

1/Here is DEA’s complete safety plan for legacy pain patients left stranded when they just shut down a California doc who saw “opioid refugees” It’s a list of ERs!😨 DEA closed down a doc. Within days, one I previously interviewed is dead by suicide and another is scrambling

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@StefanKertesz

Stefan Kertesz, MD, MSc

2 years

You know it’s Passover when @Publix stocks up on mountains of “Not for Passover” Matzah @JewWhoHasItAll #Pesach

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@StefanKertesz

Stefan Kertesz, MD, MSc

1 year

@realchrisrufo Often, when companies fire executives, it has to do with profits and losses.

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DISNEY SHAKEUP: Bob Iger Back as CEO, Bob Chapek Out; Board Cites ‘Complex Industry Transformation’...

In a shocking shakeup, Disney's board has reinstated Iger as CEO, ousting Bob Chapek and reinstating Iger nearly three years after he stepped down.

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@StefanKertesz

Stefan Kertesz, MD, MSc

6 years

Ten tweet thread on suicidal feelings & expressions as they find expression in online communities, not formal medical advice, but trying to be practical.

@StefanKertesz

Stefan Kertesz, MD, MSc

6 years

1/Suicide is being noticed as a component of opioids both in addiction and in the fate of some patients being cut off. Let me stare something I hope will be practical

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@StefanKertesz

Stefan Kertesz, MD, MSc

2 years

1/Any rational discussion of homelessness needs to be explicit about the long-term decline in the total number of units rentable to persons who make below median or below 30% of median.

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@StefanKertesz

Stefan Kertesz, MD, MSc

4 years

If everyone likes you, you’re doing something wrong

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@StefanKertesz

Stefan Kertesz, MD, MSc

8 months

1/I watch with concern as DEA prosecutions of MDs still seem to rely on “they prescribed more than I would” despite a 9-0 ruling of Supreme Court last year Sudden termination of opioids & progressive abandonment of 5-8 million patients is dangerous

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@StefanKertesz

Stefan Kertesz, MD, MSc

1 year

1/The Economist recently declared that syringe exchange programs “kill” their clients, relying on a statistical modeling paper by @analisapackham My biostatistical partner & I wrote the Economist - as our letter wasn’t published, we share it here 🧵

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America’s syringe exchanges might be killing drug users

But harm-reduction researchers dispute this

www.economist.com

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@StefanKertesz

Stefan Kertesz, MD, MSc

5 years

Bravo CDC and FDA! —a great day for patients with pain: Two federal agencies have spoken forcefully AGAINST mandated or precipitous #opioid reductions in chronic pain patients. Read @cdcdirector @US_FDA letters, and our press release here: @slsatel

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@StefanKertesz

Stefan Kertesz, MD, MSc

2 years

@DCDoc33 If one has money, control over work conditions & lives in a state with high rates of vaccination, all of which apply to @DrLeanaWen and @MonicaGandhi9 , the only thing left for them to do is brag to the public about how good life can be if one’s well-off.

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@StefanKertesz

Stefan Kertesz, MD, MSc

8 months

1/Governor Gretchen Whitmer of Michigan has declared September “Drug Free Pain Management Awareness Month” Her statement gives the appearance of having been drafted by a chiropractic professional society, since chiropractic is the ONLY therapy named

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@StefanKertesz

Stefan Kertesz, MD, MSc

6 years

1/Suicide is being noticed as a component of opioids both in addiction and in the fate of some patients being cut off. Let me stare something I hope will be practical

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Suicide Emerges In Understanding The Opioid Epidemic

Last year, Massachusetts began recognizing that some opioid overdose deaths are suicides.

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@StefanKertesz

Stefan Kertesz, MD, MSc

3 years

As opioid litigation progresses, I want this known: Legal teams sought me for both sides My priority is *protection of life*, especially patients with long term pain (addiction too). Taking money would have harmed credibility & could’ve put lives at risk Saying “no” was easy.

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@StefanKertesz

Stefan Kertesz, MD, MSc

5 months

Nothing says “this is a promising technology” quite so powerfully as 85% of FDA’s expert advisors voting that its risks far outweigh its benefits

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@thehill

The Hill

5 months

FDA approves first ever DNA test to help screen for risk of opioid use disorder

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@StefanKertesz

Stefan Kertesz, MD, MSc

5 years

A large multi-state chain of pain management practices is eliminating prescriptions within 30 days. It's not hard to imagine a difficult challenges for patients. #opioids . This is what happens when we convert patients on medication into liabilities.

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@StefanKertesz

Stefan Kertesz, MD, MSc

4 years

“I lost my husband in 2017 by suicide after his medications were taken away. To see Dr. Kertesz and his colleagues take this seriously matters to me because nobody should lose a loved one over something treatable.” Our research to stop this starts now

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UAB team investigates suicide, opioid prescription changes

As the country has grappled with an opioid crisis and with COVID-19, a third crisis has brewed. Suicide is now the 10th leading cause of death in the United States.

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@StefanKertesz

Stefan Kertesz, MD, MSc

3 years

1/This week I received reports of several deaths after forced opioid taper, including a CSI:OPIOIDs collaborator.For that, there are no words Our @OnHealer episode on Forced Taper touches on a way forward, based on genuine respect for patients

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@StefanKertesz

Stefan Kertesz, MD, MSc

4 months

I have a family member with cancer. She met an interdisciplinary team, along with a care navigator. One by one every specialist reviewed all they knew and would do, with the others listening and adding comment. It was good care And I thought “why can’t we do this for my patient…

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@StefanKertesz

Stefan Kertesz, MD, MSc

5 years

1/Let me share my view on the 3rd study of 2019 showing pain patients are not always safer after opioid stoppage, under real world conditions. A 3-fold increase in overdose death draws my eye. Don’t jump to conclusions, but let's study what was found

Researchers find alarming risk for people coming off opioids - UW Medicine | Newsroom

Patients on chronic opioid prescriptions who came off opioids were three times more likely to die of an overdose in the years that followed, a study found.

newsroom.uw.edu

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@StefanKertesz

Stefan Kertesz, MD, MSc

1 year

My doctor says they have to lower my long-term opioid medicine. “What can I do? What do I say?” In preparation for re-launching our suicide study, I'm offer this draft guide for patients and families. I would be thankful for your feedback

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@StefanKertesz

Stefan Kertesz, MD, MSc

4 years

@NPR @hereandnow Dr. @AjayManhapra reminded me he was chewed out by supervisors for wanting to prescribe ONE single Vicodin to a black woman, while the same hospital berated him for NOT offering MORE opioids to a white woman who was snowed. Why is this worth celebrating, @WBUR ? @hereandnow

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@StefanKertesz

Stefan Kertesz, MD, MSc

6 years

10/The paradox of suffering is that it is often ours alone, and yet the sufferer is also connected to every other who has born the “mark of pain”, as Dr Albert Schweitzer phrased it, a Fellowship not to forget

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@StefanKertesz

Stefan Kertesz, MD, MSc

1 year

Good work doesn't have to be seen, but I am thankful when it is Thanks to UAB's Department of Medicine for the Max Cooper Award for Excellence in Research Thanks to @vahsrd @UABNews many collaborators, and family

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@StefanKertesz

Stefan Kertesz, MD, MSc

3 years

Heard today: “You walk in, mention #pain , and this ‘drug-seeking’ light goes off in the providor's eyes and no one takes 3 minutes to listen” That's a 72 year old man, whose Catholic wife says suicide is a mortal sin. But she prays for God to take her. (with permission)

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@StefanKertesz

Stefan Kertesz, MD, MSc

4 years

I have a GREAT idea if you are planning to host a party. Don’t. Even if you are a bunch of doctors

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@StefanKertesz

Stefan Kertesz, MD, MSc

2 years

The US accounted for 53% of world opioid consumption according to my review of the UN International Narcotics Control Board report of 2020. I converted to MME, from Tables XII/XIII Using raw weights, the US consumes 27% 80% has never been true.

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@StefanKertesz

Stefan Kertesz, MD, MSc

6 years

I cannot imagine a more violent rejection of the CDC Guideline on Prescribing Opioids of 2016 than the plan current before Oregon Medicaid : forced taper to 0 mg of all opioid receiving pain patients.

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@StefanKertesz

Stefan Kertesz, MD, MSc

2 years

2/Both @DEAHQ & @CDCgov have told the public that they will *protect* the safety of these legacy opioid-receiving patients when law enforcement leaves them stranded WHERE is CDC’s Opioid Rapid Response Program? Bueller? A list of ER’s? Really?

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@StefanKertesz

Stefan Kertesz, MD, MSc

4 years

A husband killing himself and his wife with Alzheimer’s is reported as a touching human interest story. A different reporting approach would treat this as a preventable death due to serious illness. Let’s interview scholars of aging, caretaker burden and health systems next time.

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@StefanKertesz

Stefan Kertesz, MD, MSc

2 years

@QueenMab87 @RBraceySherman In Judaism, the principle of saving life (“pikuach nefesh”) overrides all other religious and moral rules. For a Jew in a concentration camp with a limited chance of survival, remaining pregnant would mean increasing risk to the mother. An abortion could be “pikuach nefesh”

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@StefanKertesz

Stefan Kertesz, MD, MSc

5 years

Another day where I put in 45 minutes to try to help an opioid-receiving patient, somewhere in the USA who is being abandoned. Not sure I can come up with individualized letters for all 10 million. It would be awesome to see health systems and regulators take this on with vigor.

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@StefanKertesz

Stefan Kertesz, MD, MSc

3 years

1/For any discussion of homelessness - please remember: the key driver of *total number of people homeless* in any area of the US is the number of units that are affordable to poor renters

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@StefanKertesz

Stefan Kertesz, MD, MSc

4 years

Patients and docs: I'm looking for examples of situations where health providers have expressed judgmentalism toward patients. When does it happen? Do you have examples?

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@StefanKertesz

Stefan Kertesz, MD, MSc

1 year

@JayTownAlabama @DEAHQ @NatPoliceAssoc @NationalSheriff @GLFOP @JoeGamaldi Hello- I’m an addiction doc & Professor at UAB School of Medicine. I also published the 1st report of fentanyl in the Northern District of AL. I can provide info on why passive exposure to fentanyl does not happen in the way these news reports are suggesting if you would like.

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@StefanKertesz

Stefan Kertesz, MD, MSc

4 years

A bioethicist assesses that non-consensual taper of opioid therapy in stable patient is *not ethical*. This is the *3rd paper in one month* to speak against a practice pushed by quality metrics, by federal law, and by journalists who paint simplistic portraits of prescribing.

@TNREthx

Travis Rieder

4 years

Very happy for this paper to be out in the world. In it, I argue that non consensual discontinuation of opioid therapy for stable legacy patients is wrong. This is true even if it means prescribing opioids for a patient indefinitely. Argument preview:

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@StefanKertesz

Stefan Kertesz, MD, MSc

2 years

Published: "Accidental Occupational Exposure to a Large Volume of Liquid #Fentanyl on a Compromised Skin Barrier with No Resultant Effect" Fentanyl 380mcg-->hand+forearm+ open cut+abrasion on pharmacy tech Washed off Seen by employee health No effects

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@StefanKertesz

Stefan Kertesz, MD, MSc

4 months

"Zero opioids in our state" was not on my bingo card "We actually have an ambitious goal through this program of bringing, hard to say how much time it will take, but actually bringing opioid prescribing down to zero" Thoughts on a statewide initiative?

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Local program aimed at reducing opioid prescribing goes into effect statewide

CSS works with providers on policies around evidence-based prescribing and management of opioids.

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@StefanKertesz

Stefan Kertesz, MD, MSc

5 years

This is our letter to @CDCgov about misapplication of its #opioid Guideline. We took time to make it short, clear, and scientifically careful. Take a look.

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healthprofessionalsforpatientsinpain.org

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@StefanKertesz

Stefan Kertesz, MD, MSc

2 months

Insurance companies have weaponized the prior authorization process, reports this @nytimes video op-ed This delays or stops care 1 in 3 doctors assert such delays have caused death or harm to patients Doctors’ offices have to hire staff purely to handle prior authorization…

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@StefanKertesz

Stefan Kertesz, MD, MSc

2 years

The next CDC Opioid Guideline draft is coming: Be ready to speak LOUDLY to protect patients who were *not protected* by institutions that gave that the 2016 Guideline regulatory force, without regard to the the complexities of scientific evidence

@speakingabtpain

Kate Nicholson

@speakingabtpain

2 years

Super important for anyone interested in #OpioidPrescribing .

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@StefanKertesz

Stefan Kertesz, MD, MSc

9 months

Our study to understand loss of life by suicide after prescription opioid reduction or taper never stops- Study meeting to discuss protocols from DFW… Learn more

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@StefanKertesz

Stefan Kertesz, MD, MSc

4 years

1/Last week we launched CSI:OPIOIDs, our research survey for bereaved families+friends who have lost a person with pain to suicide during a change in opioid prescribing. I want to say why this matters (fyi: it's at ,or type URL if click-thru fails). First:

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@StefanKertesz

Stefan Kertesz, MD, MSc

5 years

“Marijuana is not a panacea”. It’s sometimes assumed opioids are routinely replaceable with marijuana. We don’t have data to support that. Opioids are not an easy treatment to consider. They are problematic. Marijuana is not the quick fix to a complex issue.

@Newsweek

Newsweek

5 years

Can medical marijuana replace prescription opioids? Pain patients call for a hard look at the evidence, despite enthusiasm among doctors and Pete Buttigieg

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@StefanKertesz

Stefan Kertesz, MD, MSc

7 years

What is a research report? Superb schematic for scientific writers #writing

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@StefanKertesz

Stefan Kertesz, MD, MSc

4 months

The pain doctor wrote “withdrawal is uncomfortable but won’t kill you” for his patient with muscular dystrophy on a ventilator (!) I have to wonder if they knew of the 2016 article by Shane Darke in @AddictionJrnl

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@PainPtFightBack

Anne Fuqua

@PainPtFightBack

4 months

Looking for words to describe this situation, I’m at a loss. 31 yo w/ Duchenne MD. Trached, on vent. Dilated cardiomyopathy. Fresh compression fractures. D/C’d from pain mgmt after ED wrote Rx. Pain MD “W/D is uncomfortable, but won’t kill you.”

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@StefanKertesz

Stefan Kertesz, MD, MSc

6 years

A very direct column in WaPo by a person who lives with extraordinary pain: The other opioid crisis: pain patients who can’t access the medicine we need:

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@StefanKertesz

Stefan Kertesz, MD, MSc

1 year

1/There are 32k comments in DEA's docket on telehealth for initiating a controlled substance other than bupe for OUD (DEA-407) My colleagues & I focused on protecting pain patients who are cut off from prescribed opioids Feel free to read it:

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@StefanKertesz

Stefan Kertesz, MD, MSc

7 months

In this paper, large increases or decreases in Rx opioid dose ⬆️ the risk of overdose death. Going from >90 MME to 0-29 MME in 30 days was associated with a 4x ⬆️risk of OD death Agencies forcing these changes include insurers & legal investigators

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@StefanKertesz

Stefan Kertesz, MD, MSc

4 years

When an outlet I love and support publishes false information as factual, it raises questions about bias and balance, which is serious here. In this case it is the “80% of the world’s opioids” figure which has been debunked by me and by others.

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Doctors And Dentists Still Flooding U.S. With Opioid Prescriptions

Forty Americans die every day from overdoses linked to prescription opioids, but researchers say many doctors and dentists still have a "prescribe and forget" attitude toward the medications.

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@StefanKertesz

Stefan Kertesz, MD, MSc

3 years

@EricaMichelle44 This is, as you describe it, a possible violation of the Americans with Disabilities Act - that makes a disability attorney familiar with the ADA a potentially valuable next step

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@StefanKertesz

Stefan Kertesz, MD, MSc

4 years

Opioid tapering is disproportionately carried out on Blacks and women and people with severe complex illnesses. Rapid tapers violating CDC’s 2016 guidance occurred for ~1 patient in 5. Whether one believes tapers confer safety or not, this is troubling

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@StefanKertesz

Stefan Kertesz, MD, MSc

2 months

Lauding jail as a place for recovery expresses desperation for healing structure. But the jails being lauded are often death traps Giving birth, unattended, on the floor of a prison shower because a woman told a cop she used cannabis. Is this healing?

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An Alabama woman was imprisoned for ‘endangering’ her fetus. She gave birth in a jail shower

Exclusive: Ashley Caswell, one of a growing number of jailed pregnant women in Etowah county, is suing officials after she was denied care

www.theguardian.com

@samquinones7

Sam Quinones

2 months

I've heard this, or versions of it, too often to ignore. #Jail as a place of recovery, and...as a lifesaving place you can't leave when lethal drugs tell you that you must. It's happening in fascinating ways elsewhere in the country. #WhatFentanylNowRequires #notthedrugwar

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Stefan Kertesz, MD, MSc

9 months

1/physicians cutting off opioids based on a +ve “(meth)amphetamine” test is problematic First the rate of false positives for the amphetamine screening assay (antigen tests, EMIT, ELISA) is high, up to 91% in one study

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Predictive Value of Positive Drug Screening Results in an Urban Outpatient Population

Abstract. Urine drug testing (UDT) has become an essential component in the management of patients prescribed opioid analgesics for the treatment of chroni

academic.oup.com

@ibdgirl76

Bev Schechtman🇮🇱

9 months

On and on it goes. This is how CPP’s are being treated. I am disgusted. Health care is broken.

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@StefanKertesz

Stefan Kertesz, MD, MSc

6 years

When the PI for a major #opioid trial has to correct @nytimes inaccuracies in the COMMENTS section, there is a reporting problem.

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@StefanKertesz

Stefan Kertesz, MD, MSc

3 years

Thus pulmonary specialist “is tired of walking out of an ICU where #COVID -19 has killed another patient, and walking into a grocery store where he hears people saying it doesn’t exist.” - that denial is a part of fatigue for health care workers

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@StefanKertesz

Stefan Kertesz, MD, MSc

6 months

1/Arguing for methadone deregulation, Dr. Ruth Potee notes that in an auditorium of 400 addiction specialists, almost NONE prescribe methadone (because they can't) "Methadone is a miracle drug that no one has access to" There are more people who offer Botox than offer methadone

@StefanKertesz

Stefan Kertesz, MD, MSc

6 months

The ⁦ @AMERSA_tweets ⁩ plenary debate on methadone deregulation will be *educational* - debate partners Dr Ruth Potee & Denis Antoine III will actually switch sides and t-shirts midway through

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@StefanKertesz

Stefan Kertesz, MD, MSc

5 years

Not all opioid prescriptions are for wisdom teeth extractions. Please consider dialogue, Senator @gillibrandny

@gillibrandny

Sen. Kirsten Gillibrand

5 years

If we want to end the opioid epidemic, we must work to address the root causes of abuse. That’s why @SenCoryGardner and I introduced legislation to limit opioid prescriptions for acute pain to 7 days. Because no one needs a month’s supply for a wisdom tooth extraction.

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@StefanKertesz

Stefan Kertesz, MD, MSc

6 months

Truth💣 1/ The “NARXCare” opioid Rx risk algorithm is in all Prescription Monitoring Databases,ie ~1 bn Rx’s/year NOW in @JournalGIM ✅evidence does not yet exist to support it as safe or protective ✅It has flourished due to lack of federal oversight

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@StefanKertesz

Stefan Kertesz, MD, MSc

2 years

A major network of pain clinics in Washington state will terminate all opioid prescriptions effective 7/1/22 The @US_FDA and @CDCgov have cautioned about the risk of harm to these patients. There is no current plan to honor those federal warnings

@WAMedCommission

Washington Medical Commission

@WAMedCommission

2 years

WMC takes prescription of opioids and pain treatment, the laws and rules that advise patient harm very seriously. The WMC is aware of the changes enacted by Virginia Mason Franciscan Health. @ibdgirl76 @life_is_art___ @elizabe50286054 @funchefchick @jnicky63 @CivilRights

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@StefanKertesz

Stefan Kertesz, MD, MSc

7 months

Real request from a patient “Doc, would you send me more Narcan? It’s over 12 people I’ve saved with Narcan from the VA” 🚨The naloxone we prescribe is never just for the patient who receives it.

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@StefanKertesz

Stefan Kertesz, MD, MSc

2 years

@RobinsonCarol @lee_hedgepeth It is very important for some of us who oppose state-imposed death penalties It illustrates the distance between our moral priorities (“don’t take life”) and the state’s priorities (“don’t wear a short skirt when we carry out a legal killing”)

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Stefan Kertesz, MD, MSc

3 years

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

@johannhari101

Johann Hari

3 years

The US - after years of having a drug warrior as president - just had its deadliest year of drug use ever. Know where isn't having a deadly year? Portugal, where they decriminalised all drugs, & r now close to the bottom of EU league tables for drug harms

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Stefan Kertesz, MD, MSc

4 years

“Um, because that’s his job?” Here, a *palliative care doctor* gets a letter from Express Scripts flagging him as an outlier opioid prescriber compared to internists. —-> KEY: Institutional metrics of success in health care can wind up at odds with clinical metrics for good care

@ChadDKollas

Chad D. Kollas, MD (he/him/his)

4 years

Dear @ExpressScripts , A few facts RE: your recent letter 👇🏼about the #OpioidCrisis : 1) I’m boarded in #HPM and practice that specialty full-time (my cohort is NOT internists! 🙄) 2) The vast majority of OD deaths are NOT from Rx meds. Stop the harmful #FalseNarrative !

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@StefanKertesz

Stefan Kertesz, MD, MSc

6 years

One-third of cancer patients report insurers refused to cover #opioid meds, and 1/4 report pharmacists refused to fill their #opioid Rx. Are untreated cancer patients going to pave our path out of a national addiction crisis?

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Cancer Patients Face Difficulties in Getting Opioids

In the wake of policies meant to stem abuse, cancer patients and survivors report that they are now finding it more difficult to obtain opioid prescriptions.

www.medscape.com

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@StefanKertesz

Stefan Kertesz, MD, MSc

2 years

3/Writing in @NEJM this year Dr Phillip Coffin named both the risks to these patients and the collective responsibility to assure that law enforcement or revised standards of care do not cause their death. This is common sense

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@pcoffin

phillip coffin

2 years

We have to stop abandoning patients, just because they have been receiving opioids.

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Stefan Kertesz, MD, MSc

6 years

2/I am not here to speculate “why” here save to note that pain, addiction & opioid taper/discontinuation all have correlations with suicide, and that means we have many many people at risk right now

@SAj_AMERSA

SAj_AMERSA

6 years

2. In two sets of fiscal years — 2010-2011 and 2013-2014 — opioid discontinuation was NOT associated with overdose mortality but was associated with INCREASED suicide mortality.

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@StefanKertesz

Stefan Kertesz, MD, MSc

6 years

Clinicians (MD/DO, RN, NP, PA, PhD) can sign a letter of opposition to CMS plan to prevent coverage for any Medicare C/D patient #opioid at >90 MME. This will be public. Put your degree & institution:

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Unhelpful and Risky: Health Professionals’ Response to the 2019 CMS Plan Due 3-5-2018 10pm

docs.google.com

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Stefan Kertesz, MD, MSc

4 years

1/Hydroxychloroquine (HCQ) is looking worse&worse as an option for care of #COVID19 The best new study offers a *superb* example of a statistical approach to data where treatment wasn't randomly assigned. I'll summarize the finding and "propensity scores"

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Observational Study of Hydroxychloroquine in Hospitalized Patients with Covid-19 | NEJM

Hydroxychloroquine has been widely administered to patients with Covid-19 without robust evidence supporting its use. We examined the association between hydroxychloroquine use and intubation or de...

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@StefanKertesz

Stefan Kertesz, MD, MSc

6 years

Your #opioids were cut, and you faded gently. Unable to take meds to protect your transplanted kidney, you filled up with fluid. Once the docs knew you would die, they infused dilaudid until you were dead. You never complained. #ShareAStoryInOneTweet

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@StefanKertesz

Stefan Kertesz, MD, MSc

2 years

I am delighted with this 9-0 decision of the Supreme Court. I am proud to have provided scientific input to the amicus brief from @national_pain , which cites our 2020 paper with @AllysonVarley @BethDarnall on harms of poor implementation of changes to opioid policy

@national_pain

National Pain Advocacy Center

2 years

Today #SCOTUS ruled unanimously in Ruan v. United States, that doctors authorized to prescribe controlled substances can only be convicted for violating the Controlled Substances Act when they intend or know that they are prescribing in an unauthorized manner.

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Stefan Kertesz, MD, MSc

5 years

“The assumption that forced #opioid taper is reliably beneficial is not supported by evidence, and clinical experience suggests significant harm” — .. so why exactly are we doing this again?

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Rapidly taking patients off opioids might not be a good idea, experts say

Nearly 18 million Americans are long-term opioid users because of chronic pain. In the wake of an opioid addiction crisis that has claimed thousands of lives, health regulators and the medical...

uk.news.yahoo.com

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@StefanKertesz

Stefan Kertesz, MD, MSc

4 years

The closure of pain management practices may be seen as a “win” for some parties, but efforts to protect dislodged patients are hodgepodge. Let us insist that regulators & payers protect patients in these situations. It is not rocket science to do so.

@elaineous

Elaineous🏳️‍🌈

4 years

@ravensspirit68 @LelenaPeacock @Jonatha61596857 I just found out at my regularly scheduled Appt that my PM office is closing entirely in 90 days. I’m totally devastated. Seems unlikely I’ll find a new doctor to continue my current Rx level in that time (or at all for that matter). Almost 10 years of treatment. I’m so scared.

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Stefan Kertesz, MD, MSc

2 years

@JLBanks9 A very gentle call out “Often when I don’t understand the reason a person does something, I learn a lot by asking them”

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Stefan Kertesz, MD, MSc

4 years

1/Published: “Nonconsensual Dose Reduction Mandates are Not Justified Clinically or Ethically: An Analysis” -In Journal of Law, Medicine & Ethics, with @AjayManhapra @AJ_Gordon . Given the paywall, I’ll offer key points #ChronicPain #opioids

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Stefan Kertesz, MD, MSc

5 years

Let’s commend protective steps by WA Dept of Health, which:(a)declared it knows of patient harms from abandonment of pain patients & forced taper;(b)declared it does not support that;(c)laid out patient-centered reasons that could justify taper #opioids

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@StefanKertesz

Stefan Kertesz, MD, MSc

4 years

Guidance from @CDCgov on homelessness and #COVID19 : (1) don’t clear encampments (space the tents!) ; (2) provide latrines, hand washing, sanitation; (3) develop isolation housing for potential infected persons (empty hotels?) ; (4) protect outreach staff.

@ChicagoStMed

Chicago Street Medicine

4 years

The CDC just released guidance for responding to #COVID19 among people experiencing unsheltered #homelessness . Three main buckets: partnerships, prevention, and isolation.

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@StefanKertesz

Stefan Kertesz, MD, MSc

4 years

“Four US doctors convicted of fraud in $150m scheme to swap opioids for back injections” : I hear this about often. Reprehensible exploitation of long term opioid recipients is one side effect of our policy responses. @tal7291

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Four US doctors convicted of fraud in $150m scheme to swap opioids for back injections

Four physicians from Michigan in the US have been convicted of fraud after providing 6.6 million doses of medically unnecessary opioids to patients. In return for receiving the prescriptions, the...

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@StefanKertesz

Stefan Kertesz, MD, MSc

1 year

Patients with long term pain and history of opioids being prescribed are often unable to find a doctor after one quits or comes under investigation. It is bizarre to read the Department of Justice accusing these patients of not seeking care, in court.

@PainNewsNetwork

Pain News Network

@PainNewsNetwork

1 year

A DOJ attorney is #gaslighting #pain patients by claiming they were unwilling to find new providers after their doctor's license to prescribe opioids was suspended by DEA. Patients say the allegation is absurd. #cpp #chronicpain @DEAHQ @AnneMilgram @DOJPH

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Stefan Kertesz, MD, MSc

1 year

Communication with patients is, often, horrific. I have a dad in hospital for recurrent atrial fibrillation after (failed) ablation After 3 days, my dad- a rocket scientist- has no idea if his a-fib has ceased. Why not? Because no one could be bothered to tell him

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@StefanKertesz

Stefan Kertesz, MD, MSc

1 year

1/There are 3 patient deaths in the 5 weeks since DEA revoked the certificate of one LA doctor who served “pain refugees” I read DEA’s court filing- some patients had high doses & drug combinations. No allegation beyond that. @keegan_hamilton story on 2:

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@StefanKertesz

Stefan Kertesz, MD, MSc

2 years

Me: Those burning cigarettes are still not good for a man who had a triple bypass. Him (glance down): yeah Me: What did you think of those nicotine lozenges? Or the patches? Him: Sort of okay. But I still gotta smoke, doc Me: Have you considered vaping? #HarmReduction

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Stefan Kertesz, MD, MSc

6 years

Deadline coming. CMS proposals on #opioid coverage for pain will cause CHAOS, NOT safety. Plan: deny coverage for all patients on >90 mg. This is not evidence-based. People who care: stand up for your fellow Americans by March 5, 1159pm EST:

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Stefan Kertesz, MD, MSc

1 year

10/To protect pain patients, here is Rec #2 from @maiasz US Attorney General can instruct DEA to stop pursuing doctors just because of high Rx doses or risky drug combinations. "If there is no other signal of criminal intent, this is not a matter for federal law enforcement"

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@StefanKertesz

Stefan Kertesz, MD, MSc

4 years

Note from a patient: “You guys saved my life and helped me even when I wasn't sure that I wanted help. You cared for me when I wasn't able to care for myself. I will be forever indebted to all of you. You all worked very hard to get me well. Thank you everyone.” ❤️

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@StefanKertesz

Stefan Kertesz, MD, MSc

4 years

“Drug Seeking”? Clinicians apply this pejorative to avoid confronting some truths about their own limitations, discomforts, and judgmentalism. Honesty is better. The clinician can write “I don’t know what to do” or “I have no tools that can help”

@carolinedoulalv

Caroline Hurst-Millican

@carolinedoulalv

4 years

Apparently drug seeking behavior and non complaint behavior go along with chronic pain and pregnancy. Feeling defeated and self worth is shot. @CMerandi

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@StefanKertesz

Stefan Kertesz, MD, MSc

1 year

@ibdgirl76 @RonChapmanAtty @jenndoliva @maiasz No there is *no such DEA rule*. However the question is whether anyone at the doctor’s office spoke to a local agent and got informal advice But this is invoking a rule that does not exist- asking @speakingabtpain or @LeoBeletsky to fact check me

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Stefan Kertesz, MD, MSc

1 year

"Gabapentin Will Not Cure the #Opioid Crisis" Editorial on the reported increase in off-label gabapentin prescribing (2006-2018), as originally describe by RAND team led by Evan Peet- comment by Audrey Han and Raegan Durant-

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@StefanKertesz

Stefan Kertesz, MD, MSc

5 years

Only 49 other states need to take the same step to begin to avert needless loss of life.

@StefanKertesz

Stefan Kertesz, MD, MSc

5 years

Let’s commend protective steps by WA Dept of Health, which:(a)declared it knows of patient harms from abandonment of pain patients & forced taper;(b)declared it does not support that;(c)laid out patient-centered reasons that could justify taper #opioids

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@StefanKertesz

Stefan Kertesz, MD, MSc

1 year

2/In ‘Entire Body Is Shaking’: Why Americans With Chronic Pain Are Dying" @maiasz presents Anne Fuqua- who I met in 2017. She finds 932 suicides, 235 "documented with materials like news articles, suicide notes, family accounts & medical records"

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