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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
Or we do better teaching. As a patient and nurse I always recommend using a safe or locked box to store meds, all meds.
After TAH I had to travel 125 miles round trip to get refill RX for pain meds as GYN only wrote for 4 days worth post op meds upon discharge. Traveling in the car, the August 100+ heat, & having to wait over an hour at the pharmacy all worked AGAINST my ability to rest & heal. 
Many believe that Tylenol, NSAIDs, Aspirin have no risk, because that's impression you and the government are presenting when in fact they have significant risk, esp. when used chronically & in elderly which is what is happening now. People need to understand only for short term.
Pain patients have taken on theirselves to keep these meds under lock and key. We do not want them diverted either.
#opioidmyths Re:diversion The DEA states clearly that diversion by patients is less that 1% of the illicit market. Look to losses/thefts from Pharmco's, pharmacies, and hospitals. RXmeds are NOT being diverted by the patient base.
Your example here is a good part of the problem. You cannot generalize pain. There are some peds that will need opioids for a tooth extraction and many with migraines who will need opioids. When you put it out there that it's not okay for someone you create stigma.
Humans who are opioid tolerant are being sent home w/at most a 7-day supply. If you understood the difficulty of getting to your doctor & then the pharmacy after major surgery w/o a helper...you might rethink OR aftercare. Try to imagine ER tx. /Shudders #TreatIndividualspic.twitter.com/rKTB6jla7j
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