Equality Couple

🧵 I really wish this Christmas people would stop, take a step back & look at the big picture. We are AMERICA "Land of the Brave, Home of the Free". Are we really? I have to wonder with all of the hateful culture wars, violent hateful rhetoric, & mass shootings by right wing 1/

A friend of mine who works outside healthcare: The doctor called me “non compliant” in their note! Me: What? Why? Her: I asked how much the cost of the medication was and told them I couldn’t afford it. Me: Let’s call and demand that they change it. Her: Thanks. I literally don’t know what I did wrong. Fellow healthcare professionals, your patients ARE reading your notes on MyChart. Please don’t label anyone as “non compliant” when you really mean barriers to access to care.

Lifestyle habits matter. That’s not the debate. Duh What needs to end is the moral superiority around not taking medications. I’ve watched too many people suffer in silence. Told to just “try harder.” Eat better. Move more. Stress less. Like no shit Sherlock, they are already doing that. Because here’s the reality: You cannot out lifestyle every disease in every season of life. And when people are already doing the best they can and still need meds, shaming them isn’t empowering… it’s reckless. So before you tell someone to skip medication and “just optimize their lifestyle,” ask yourself: If they delay care and something happens… are you willing to own that?

Building a giant Arc in DC is a colossal WASTE of taxpayer money at a time when folks are literally going without basic necessities BECAUSE of the Trump regime. #WakeUpAmerica

@Matt_Pinner Part, Fart, Cart, tart, dart....

Starts with P and ends with T. Can you think of ONE word?

@SheepHeadLori @ChadDKollas It started before there was a generic available for Suboxone. Andrew Kolodny & PROP at Stanford convinced the CDC that prescription opioids were to blame. They stood to make millions on Suboxone. The brand name for Buprenorphine if their little plan would've worked.

@EqualityCouple @ChadDKollas How do they make more? I saw one form of Buprenorphine is a generic sublingual pill?

I am officially on my last nerve today with medical disinformation on opioid therapy and pharmacists who are at the peak of the curve that describes the Dunning Kruger Effect (original paper from 1999 can be found at pubmed.ncbi.nlm.nih.gov/10626367/). Here are the facts about opioid therapy: 1) The @US_FDA has approved opioid analgesics as safe and effective when prescribed appropriately for moderate-to-severe pain. Because they are safe and effective when prescribed appropriately for moderate-to-severe pain. 2) It is ethically impermissible to deprive patients from an established therapeutic benefit in a randomized, placebo-controlled clinical trial (RCTs); after a drug has been proven effective, studies that examine its long-term effectiveness should involve randomized comparisons to other drugs, such as in Enriched Enrollment Randomized Withdrawal (EERW) studies. Critics who wrongfully insist that we must have RCTs to justify the use of Long-term Opioid Therapy (LTOT) are either disingenuous or they are woefully uninformed (again, see the Dunning-Kruger Effect). 3) According to FDA Postmarketing Studies (PMRs) on opioid therapy, the prevalence of addiction in patients taking opioids for pain - operationalized BROADLY by the @US_FDA as patients meeting DSM-5 Criteria for moderate-to-severe opioid use disorder (OUD) - is approximately 1.5%. The prevalence of alcoholism in adults using ethanol is about 10% and the prevalence of tobacco addiction in adults who smoke is about 60-80%. Again, critics who refer to the risk of opioid addiction as "high" either lack the knowledge to appropriately contextualize that risk (Dunning-Kruger again) or they are disingenuous. 4) Buprenorphine is indeed a useful medication for treating both chronic pain and OUD, but it is too early to label it as the drug of choice for cancer pain or chronic, non-cancer pain. The largest review of buprenorphine in palliative care [Thakkar, et al. J Pain Symptom Manage. 2025 Dec 29:S0885-3924(25)01016-4] "found consistent evidence that buprenorphine was comparable to other full opioid agonists when used as both a short-acting and long-acting analgesic for palliative care patients. It also did not display significant differences in risks of adverse effect." Additionally, the authors observed, "While buprenorphine’s superior safety profile, particularly its lower risk of respiratory depression and overdose compared with full opioid agonists, is well established in the literature, none of the included palliative care studies reported on respiratory depression." Given this, it is also premature to conclude that buprenorphine is truly a safer option for LTOT than other full-acting opioids (FAOs); although that argument is a rational one, it remains unproven. 5) There is a substantial and growing body of evidence that suggests that abruptly discontinuing LTOT or reducing opioid doses too rapidly may cause patient harms including uncontrolled pain, mental health crises, increased risk of self-harm or suicide and increased risk of overdose from illicit fentalogues (See, for example, Oliva et al. BMJ. 2020 Mar 4;368). Discussions about reducing opioid dose or transitioning to buprenorphine should include a comparison of these risks versus the risks of LTOT. Additionally, clinicians must transition from a recovery model of illness to a model that acknowledges that some patients have PERMANENT, INTRACTABLY PAINFUL conditions that justify the use of LTOT under the ethical principle of double-effect. 6) The systemic vilification of opioid medications that began with the 2012 PROP Petition to the FDA on Opioid Labeling occurred - at least in part - to support large-scale multidistrict litigation (MDL) against opioid manufacturers and distributors. Many of the medical experts involved these lawsuits inappropriately influenced federal opioid policy despite having undisclosed financial and professional conflicts of interest that should have disqualified them from participating in the policy creation process [see Kollas CD, Boyer-Kollas B. Chapter 15: Laws and Policies Affecting Pain Management in the United States. Bonica’s Management of Pain, 6th Edition (James P. Rathmell JP, Edwards RR, Gilligan CJ). Wolters Kluwer, 2026, ISBN: 9781975222369. In press for Fall 2026]. 7) Ultimately, all pain care should be individualized and compassionate, make use of evidenced based treatments (that use both medication and non-medication-based approaches) and, when appropriate clinically, may include opioid therapy with a focus on optimizing therapeutic benefits while mitigating risks of both long- and short-term side effects, including the risk of OUD; patients with OUD or opioid addiction should enjoy the same level of access to individualized, compassionate care as patients with chronic pain. That level of care is detail-oriented, time-consuming and professionally challenging - but all of our patients deserve nothing less.

@Breelee420 I’m on hospice and can’t even get 1 extended release pill. Waking up all through the night is horrible pain😭

@bar98438 @Breelee420 There is no reason what so ever to withhold pain medicine from a hospice patient! WTH is hospice for if not to help the person transition with dignity & grace. Why are they afraid of addiction if the patient is dying? I mean seriously? It makes no sense. Find a better hospice.

Well I actually slept ALL night without waking up in severe pain because I finally got my 1 ER Opioid. Listen I know it’s only 12 hr Release, But it makes a HUGE difference for me. I don’t feel the horrible pain in my Sacrum area.

@AZ_Brittney Yes!

Do you agree with Tim, Joe, Jimmy and Gavin? Yes or No ✋

Children in Lubbock, Texas were admitted to the hospital with liver damage. Not from measles. From vitamin A toxicity — because their parents followed RFK Jr.’s advice and gave them cod liver oil to treat measles. He is the sitting U.S. Secretary of Health and Human Services. This is not the first time this has happened. In 2019, RFK Jr. traveled to Samoa and ran the same anti-vaccine campaign. Vaccination rates dropped to 31%. Five months later: 5,700 cases. 83 dead. Most of them children under 4. He called it a “natural experiment.” The Senate confirmed him as HHS Secretary anyway. yahoo.com/news/after-rfk… 🧵1/3

🚨NEW: Kerry Kennedy has announced Late Show Host Stephen Colbert is the recipient of the 2025 Robert F. Kennedy Human Rights Award for his advocacy for free speech and speaking truth to power. RETWEET to congratulate Colbert on this honor!

@inmedpharma Stopping the over prescribing Gabapentin to everybody for pain. & in high doses would help a lot. Gabapentin literally stops your brain synapse. That brings on brain fog, memory issues, etc...

InMed's INM-901 demonstrates a multi-factorial approach to potentially treat Alzheimer's disease, including neuroprotective effects, an ability to extend the length of neurites, which is important for brain cell-to-cell communication, as well as a reduction in neuroinflammation.

@LakotaMan1 I see you I get versions of Elon Muck that follow me anytime I mention his name. I block every one of them.

So, myself and other left wing Twitter accounts are being censored by Elon Musk. Please, tell me, do you see this tweet? Can you see me?

Can somebody please put Bibi Netanyahu in the corner? He has been a very bad boy and is the reason there will never be a cease fire. He just keeps egging it on & is refusing to stop. The problem is, NO ONE is stopping him. He's dangerous & needs to be removed from power.

How to stop an entire generation in their tracks. It’s kinda funny, but really sad at the same time.

"A man you can bait with a tweet is not a man we can trust with nuclear weapons... a war might be started... by little men, the ones moved by fear and pride." Hillary was right about everything.