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1/? GM twitter! Let’s reset the discussion on pain management and opioid misuse. First, we must acknowledge/ I’ve always felt and said that we have a crisis of un and undertreated pain in the US, and it can lead to suicide, self medication w illicits, and other bad outcomes.
2/? We also have an overdose crisis in our country. It is NOW largely fueled by fentanyl, but there traditionally have been, and still are many people who first become dependent due to opioids prescribed to them - or diverted from others to whom they were over prescribed.
3/? It both can be and is true that many people benefit from opioids, while others who are getting them are seeing more downside than upside. Not either/ or. Examples of the latter are many patients (especially peds) getting dental extractions, and most with migraines.
4/? Thats why I highlight opioid alternatives where evidence suggests they provide as good or better risk/benefit. Im NOT anti-opioids, but pro better pain management. I want to ensure those who benefit from opioids get them, & those who might benefit from other meds get those.
5/? I understand many chronic pain patients feel unheard- I HEAR YOU- and I am appreciative for your feedback. Whenever I speak on opioids, I ALWAYS discuss the need to protect chronic pain patients/ not pull the rug out from under them. We must NOT target the wrong people!
6/? We must stop swinging the pendulum to extremes, and find a better balance between getting opioids to those who most benefit from them, while minimizing them for those who don’t. Opioids are BOTH being overprescribed to SOME populations, and under prescribed to others.
7/? Eg overprescribing is well documented in OR setting. Many don’t need/take all opioids prescribed & when not properly stored/ disposed of, they can be diverted. It’s why as an anesthesiologist I highlight opioid sparing anesthetics- because for many we CAN 
periop opioids.
8/? Ive also tried to respond to questions/ comments on twitter in real time- a risk as some may feel my entire position is based on 1 reference/ study that is a specific reply to a different person/ question. We review the totality of the data before taking official positions.
9/ I hope we can work together to achieve better pain management for all- those acute and chronic patients who benefit from opioids, & those populations for whom there are reasonable and often better alternatives (both pharmacologic and non pharmacologic). #betterpaincontrol4all
So, what is the answer for patients with intractable pain for whom alternative methods have failed? We have to do better.
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