(1) To my knowledge there's only only one policy issue on which I potentially disagree with President Trump. I say potentially because its so nuanced I can't yet be sure if we really disagree. It's on the issue of the proper medical uses of opioid therapy for chronic pain.
(2) Absolutely agree with Trump's laser focus on the #OpioidCrisis, which kills 60k p/a. Obama did very little to address the tragedy. I think his actions & omissions were what suited the health industry lobbyists. He also didn't want tougher sentencing if it affected minorities.
(3) Most of the opioid crisis is driven by illicit use, with drugs trafficked illegally from cartels or the diversion of pharma drugs from the supply chain before they are lawfully dispensed by pharmacies.
(4) There is a problem with lawfully prescribed drugs being misused by the patient or diverted to those to whom they were not prescribed. Doctors and pharmacists can minimize this improper use. But the devil is in the detail.
(5) To prescribe any pharma drug safely, a doctor must be both competent and ethical. The temptation to make extra money by misusing opioids is strong. Passing laws to deter, detect and prosecute doctors for this is relatively easy.
(6) Further, the technology systems to support such laws is easy and cheap to use. An opioid prescription can be tracked online from the moment it is signed to the moment it is given to the patient. It's easy to ensure the meds end up with the right patient, in the right amounts.
(7) It's easy for regulators to see abnormal prescribing patterns where such a system has been implemented. It's also easy to know which patients would benefit from opioid therapy and which would not (due to their individual risk of misuse.)
(8) Prior to the late 1990s, prescribing stronger opioids beyond the short term for non-cancer pain was frowned upon in the medical community. Then the US professional body for pain medicine issued a statement supporting the practice, provided it was done properly.
(9) This change MAY have been influenced by commercial drivers but I don't think it needs to have been. My interpretation is that this body of doctors made the change for clinical and compassionate reasons. For many years, it worked relatively well.
(10) Then the federal gov weighed in. The CDC, under Obama, drastically reduced access to therapy for law-abiding patients in genuine need. Like everything else during those years, the public was PROMISED that good people would not be targeted. Of course they were, from day one.
(11) Patients in severe chronic pain (likely to be lifelong) now had unnecessary barriers to treatment. Only licensed pain specialists could prescribe, which meant hours of travel for people in pain, and increased cost. Absolutely insane.
(12) And those were the lucky ones. Many patients could not travel or afford the increased cost, so had to go without. We'll never know how many suicides occurred because of denial of care.
(13) For this group of patients, all other options have been tried, failed, and stronger opioids are the only therapy that works. They had used them for years, without behavioral addiction. Yes they are physically dependent, but in genuine pain you don't get a high.
(14) Once a person is established on appropriate opioid therapy, many can hold down a job, safely drive a car, and have a fairly normal life. But there is constant stigma, challenge and harassment from uninformed providers and laypeople.
(15) The government needs to get out of the clinical decisions that are made by patients, in consultation with a competent and ethical doctor. Well designed regulation to address misuse should be all that is needed.
(16) Doctors who support draconian measures such as the restrictions ordered by the CDC are being paternalistic toward patients who should be allowed to make their own choices within the law. The CDC should promote patient autonomy and equip doctors to prescribe better.
(17) I support Trump's overall tough-on-crime stance and his clear compassion for the victims of improper opioid prescribing in particular. His own brother Fred Trump died because of alcoholism, & Trump is an anti-addiction hawk. Which is good. But...
(18) I've often seen recovered addicts & families of addiction victims become too black & white about substance abuse policy. I know people who are victims of barriers to proper opioid therapy. Policy analysis must be nuanced.
(19) Trump's high energy approach is needed if he is to drive through all the changes he seeks in domestic and foreign policy. I just don't want to see this one of the most vulnerable patient groups be further railroaded. I think we can ensure that doesn't happen.
(20) If Trump had not been elected, the international body count from disastrous Democrat policies would have kept growing. Many lives have been saved. Chronic pain patients need our voices added to theirs, because they are so vulnerable themselves. #HealthFreedom

(21) @threadreaderapp unroll please. ❤️
(22) Unrolled version of my thread on opioid therapy for law abiding patients in genuine need. threadreaderapp.com/thread/9787310…

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Oct 6, 2018
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The White House and then the Supreme Court will host the two ceremonies necessary for the Justice to take his seat on Monday.

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