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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
We need exceptions for [people with rare genetic illnesses that can not take NSAIDS, like myself.
#onychoosteodysplasia #kidneydisease
We support you but the exceptions need to be for all pain sufferers whom have tried alternatives and pain medications are all that gives them some life!
Yes, what you present matters because of your stature. You present as if opioids are bad but Tylenol and NSAIDs are bad too, sometimes worse, and you don't present that, thus skewing the view of those you lead and creating the fuel for stigma against those who need opioids.
Thank you sir
As MS advocate, chronic pain patient w/failed spinal fusion L2-S1 & progressive MS, I appreciate your candid comments. It would be great to have a forum w/patients like myself who have long history & records to show the decision to titrate to lower/stable dose opioids.
I can feel your sincerity & although im in severe chronic round the clock 24/7 agony 97% of my life , and grossly UNDERtreated bc my pain Dr finally caved to the 90mme here in Oklahoma , im willing to listen to your opinions with an open & common sense mind . please help us ALL.
1. Jerome, no sir, you are not reviewing the totality of the data - still. A month later from this tweet you show 80% heroin users used pain medicine before going into heroin. Again, what bout the millions of heroin users before OxyContin was even developed, so that’s not true.
2. You have another stat shows 130+ people die each day from opioids. These opioids include illicit fentanyl, carfentanyl and heroin. Don’t forget meth, cocaine and counterfeit pills. It’s not pain medicine! Come on man, talk to us. I’m here for you and ready to talk.
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