Esther Choo, MD MPH Profile picture
May 16, 2018 15 tweets 6 min read Twitter logo Read on Twitter
Gail D’Onofrio, Chair of Emergency Medicine at Yale & national expert on emergency med’s role in staunching the opioid crisis, is giving the keynote at #SAEM18. Will push out highlights here.

She started with the faces of those lost to opioids. A knife to the heart.
(Side note: as a longtime mentor to me, D’Onofrio has never minced words. True with this talk: “Most doctors know very little about addiction.” Truth.)
She’s reviewing the pathophysiology of addiction and I’m think how so much of our life is spent chasing this neurotransmitter, dopamine. #saem18
D’Onofrio: Addiction is like driving a car and seeing you are about to hit a child. You want to stop with all your heart and mind. But the breaks don’t work. #saem18
“Medically assisted treatment” is a weird term. We don’t give diabetics insulin and call it “medically assisted.” It’s just the treatment. Speaks to the stigma of this disease. #saem18
What’s the deal with Vivitrol? D’Onofrio: Recent data is overstated. Has a role in the armamentarium. But be skeptical. Not first line treatment. #saem18
Why aren’t we using effective treatments more? (Even only 1 in 3 in addiction programs!) #nuts #nuts #nuts #saem18
WORDS MATTER. This is a disease. Diabetics with glucose in urine don’t have “dirty urine.” It’s positive or negative.

And “there’s no such thing as an ‘addicted baby’! 👶🏻 (right, @stephenwpatrick?) #saem18
Initiating opioid use disorder treatment in the ED is feasible and effective.

The Yale bupe study “should have caused an earthquake”... but barely registered across emergency care.

But the earthquake is coming, says D’Onofrio.

Quick poll: if you’re an ED doc, what are your feelings about getting a bupe waiver? #saem18
She’s showing videos of leaders and innovators in emergency medicine working on this topic and I have chills over their awesomeness and dedication. Makes me so hopeful. #saem18 #opioidcrisis #heroes
We need:
1. More funding
2. Stop restricting access to bupe
3. Define, measure, & track quality of OUD treatment within EM
4. Develop further resources to support clinicians in acute care settings
We need to change how we:
*Think about opioid addiction
*Talk about opioid addiction
*Treat opioid addiction
AMEN. An incredible & inspiring talk.
Follow @DonofrioGail to track progress on this front

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More from @choo_ek

Sep 30, 2018
"What does it say about this country that this is the state of our discourse? That Kavanaugh even stands any chance of being made one of the most powerful figures in the American government, with control over life and liberty?"…
"He went before the United States Senate and showed total contempt for his vow to tell the truth. He attempted to portray a highly esteemed doctor as a crazy person, by consistently misrepresenting the evidence. He treated the public like we were idiots..."
"... like we wouldn’t notice as he pretended he was ralphing during Beach Week from too many jalapeños, as he feigned ignorance about sex slang, as he misread his own meticulously-kept 1982 summer calendar, as he replied to questions about his drinking habits ..."
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Sep 27, 2018
One of the most emotional, awful parts of today for me: 1/2 thru Dr. Ford's opening statement, I became attuned to a sense of relief. It took me a second, then I realized I was reacting to:
-Her whiteness
-Her country club background
-Her level of education & sophistication
Because surely *this* woman could be believed. A woman of color, a poor woman, an uneducated woman - these women would be dismissed, torn apart, stripped of credibility and humiliated well before the hearing today and utterly destroyed within it. 2/
And I realized the only reason I had a smidgen of hope that she would come out intact was that she was about as dominant culture as she could be, save for her gender. 3/
Read 6 tweets
Sep 7, 2018
Yale continues to elevate a School of Medicine faculty member known to have committed sexual harassment. This is how academic institutions foster a toxic culture for women…

This is my beloved alma mater, and I know we can do better @TIMESUPNOW @nytimes
Over 650 students, residents, faculty, and alumni have signed a letter to Yale President Salovey protesting this decision as well as Dean Alpern’s role in addressing harassment over the years, which included a reluctance to penalize Simons in any meaningful way.
In a painfully painful statement, Yale clarified that Simons had not been honored but rather removed from one highly prestigious endowed chair (only after protest from the family sponsoring the endowment) to another one:…
Read 5 tweets
Aug 23, 2018
Apropos of nothing, I thought I'd muse a little on what pathological narcissists do when backed into a corner.
Narcissists are self-focused, have an inflated, grandiose sense of self, and rarely cede personal goals to other ideals.
They are not oblivious to threat to self: they simply have abnormal, extreme responses to it. On the one hand, they demonstrate deficient fear processing and can be oblivious to the potentially devastating consequences of pursuing their self-serving goals.
Read 7 tweets
Aug 16, 2018
Obama’s description of Aretha Franklin, and why she moved him, is just perfection:…

“Nobody embodies more fully the connection between the African-American spiritual, the blues, R. & B., rock and roll—the way that hardship and sorrow were transformed ...
... into something full of beauty and vitality and hope. American history wells up when Aretha sings. That’s why, when she sits down at a piano and sings ‘A Natural Woman,’ she can move me to tears—...
...the same way that Ray Charles’s version of ‘America the Beautiful’ will always be in my view the most patriotic piece of music ever performed—because it captures the fullness of the American experience...
Read 4 tweets
Aug 8, 2018
Thrilled to work with @DGlaucomflecken to develop an infographic about correct nomenclature when discussing gender bias in academia. Follow along.
(By "work with" I mean I ranted for a while and he put together this whole infographic from it)
You all know this one... The Manel!
Read 9 tweets

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