pg1800

@ibdgirl76 Lots. See them all the time. For all kinds of ridiculous reasons such as THC in their urine. In elderly and other pts on stable opioids. TONS of suffering witnessed first hand.

Guess how many pain patients have been forced off of opioids and dismissed from care.

@LORWEN108 Listen to bird sounds on YouTube. Shown from a study in Switzerland to reduce anxiety and paranoia in just s few minutes. Conversely traffic noise had the opposite effect.

How to drop your CORTISOL by 43% (backed by 300+ studies) 7 proven ways: 1. EFT tapping.

@ibdgirl76 I hear you. I’m an ER and Addiction MD. Ten years ago I told my then-medical director right to his face: this “crackdown” on doctors and opioid Rx is gonna kill a lot of people. Lots of suffering too.

I have just sat through 6 hours of OIDA opioid document symposium. Once again, NOT ONE of the speakers has even bothered to mention the unmeasured astronomical harm done in the name of opioid reduction. Neither Harm Reduction nor Addiction Medicine give us a second thought. Remember, our sacrifice was demanded in the name of public health. I'm sickened and disappointed by all of them, once again.

@Kristinartz Righteous Gemstones

I'm bored...what is the best TV series you've EVER watched. I'm not talking about Survivor or Greys Anatomy. I need a show that you couldn't stop watching because it was that good.

@ibdgirl76 That is insane.

Indivior makes Purdue look like angels, yet media won't discuss it. Listen to a Suboxone clinic lie to me.

@kirsten_klang @DavidESmitty I am super sorry to hear this story....sad.

@pg18001 @DavidESmitty I won't go back to my old dentist because of that. Oral pain is in its own orbit, yet they think your current pain treatment will help with massive additional pain. Not even close!! I had three crowns by this joker and two nearly pushed me to the end of my will to survive.

OK, since I am getting pissed off about this alleged "high risk of addiction" for "prescription opioid medications," I want to break down some math. See if you can stick with me: So there are (allegedly) in the USA approximately 210,000,000 people ages 18-64. Allegedly, 12.6% of people ages 18-64 filled a prescription in 2024 (which would be 26,460,000 people). 26,460,000 X 0.1% iatrogenic OUD = 26,460. So, we could expect that 26,460 people developed some sort of opioid use disorder out of the 26,460,000 people who were prescribed an opioid in 2024. According to SAMHSA data, from the "Key Substance Use and Mental Health Indicators in the United States: Results from the 2024 National Survey on Drug Use and Health" report, "4.8 million (or 1.7% of people aged 12+) have OUD." Now, first we have to understand how this survey was conducted to learn about how its numbers may be skewed, so let's begin there. "National Survey on Drug Use and Health (NSDUH) is an annual survey sponsored by SAMHSA within the U.S. Department of Health and Human Services (HHS)." OK, so for this 2024 survey, and the report published in July 2025: 70,241 age 12+ were interviewed. 56,228 age 18+ were interviewed. 14,013 age 12-17 were interviewed. "National Survey on Drug Use and Health (NSDUH) covers residents of households and people in non-institutional group settings (e.g., shelters, boarding houses, college dormitories, halfway houses)." "The survey EXCLUDES people with NO FIXED ADDRESS (e.g., people who are experiencing homelessness and not in shelters), military personnel on active duty, and residents of institutional group settings, such as jails, nursing homes, mental health institutions, and long-term care facilities." So, since the survey excludes homeless people, like all of those living on the streets of San Francisco, Oakland, Portland, Seattle, NYC, Baltimore, and on and on, we KNOW that the numbers are skewed and that this report should indicate that there are MORE people with OUD than are being reported. With that in mind, and knowing that the report extrapolates the percentages obtained by the survey respondents out to the general population, the report indicates that: "4.8 million (or 1.7% of people aged 12+) have OUD." Recalling the earlier number listed for the number of people ages 18-64 who were given a prescription for opioids in 2024, or 26,460,000, and that given the rate of iatrogenic "addiction" of 0.1%, we would have 26,460 persons developing OUD after being given a prescription (although we would expect there to be MORE cases if we were able to obtain the numbers of prescriptions given to persons ages 12-17, but that number was not available, so we will just use the 26,460 and assume that it includes ages 12-64). So, the total number given by the report was 4.8 million. 4,800,000 - 26,460 = 4,773,540 cases of OUD in 2024 with no prescription. Mind you, we do not know whether the persons reporting OUD in the 2024 survey were given a prescription in 2024, further complicating our comparison. But, according to this data, there were 4,773,540 cases of OUD reported in 2024 FOR WHOM NO PRESCRIPTION WAS WRITTEN (and most likely this number is larger, since homeless and incarcerated persons were not interviewed). But, based on this (flawed) examination of the data, when attempting to learn how many of the people reporting OUD had been prescribed an opioid by a doctor, 26,460. ? --------------- X ----------- 4,773,540. 100 when solving for the missing number, we get 0.55 This means that one half of one percent of the people reporting OUD in 2024 had been given a prescription, and 99.45% of those reporting OUD obtained the opioid on an illicit basis. So I ask you, if the total number of opioid prescriptions filled in 2024, reported to be 120.4 Million, 99.45% of people reporting OUD in 2024 did NOT have a prescription, where is this "HIGH RISK OF ADDICTION?"

@spauldingtbear @ibdgirl76 Sure. I work in an ED. See and treat patients in pain. Was called by corporate medical “leaders” that my percentage of pts who received an Rx was outside “norms” and unless I complied I would be put on a “Performance Improvement Plan” ie precursor to termination.

@pg18001 @ibdgirl76 I know it's too dangerous to define those words too clearly, but could you give more info on the threateners?

This is what “opioid safety” looks like in 2026. 74-year-old woman. Falls → multiple fractures: collarbone, wrist, ankle & foot ER → ignores bleeding risk, gives anti-inflammatories Orthopedic surgeon → refuses pain meds Urgent care → nothing Her crime? None. No history of misuse. Her reality? Begging for relief while her hand is swollen, black, and broken. Told: “No medication unless you have surgery.” Weeks of suffering. Depression. Abandonment. We didn’t fix a crisis. We created a new one.

@aliciaandrz @_mrseras I’m an addiction doctor. My patients face this bias and stigma all day every day. From every direction and everyone.

@_mrseras yes, I feel like if the discussions were about addiction as an illness more broadly we could stop with this moralizing weight loss nonsense.

the GLP-1 discourse around weight loss is weird because I went from a lifetime of food & alcohol addiction to freedom on the lowest dose. I used to eat until I felt sick. I used to wake up on the weekends & want to start drinking immediately. all that noise is gone. so frankly I don’t care how I’m perceived. these drugs are a miracle & weight loss is the tip of the iceberg.

@aliciaandrz I’m super happy for you. Keep going.

@RachieRach429 Happy Birthday!

It’s my birthday. Yay.

@TheXMatriarch Made me suicidal

Men can endure a lot. But being chronically undesired by your own wife while remaining expected to be tender, loyal, and cheerful is a brutal test.

@DutchRojas #truth

Four Lessons Physicians Refuse to Learn 1. Nobody stole independence. The architecture eliminated it. The talking point is that 75% of physicians left independent practice. That frames it as a choice. It wasn’t. Reimbursement cuts, regulatory burden, and payer consolidation were designed, by lobbyists and lawmakers, to make independence economically irrational. Consolidation wasn’t an accident. It was an output. The system was architected to produce exactly this result, and it did. 2. A million high-earners with no lobby is a policy disaster. Physicians are among the highest-earning professionals in the country, and they have virtually no organized political presence. They don’t give. They don’t lobby. They don’t show up. That vacuum gets filled by hospital associations, carrier lobbyists, and PBMs who write the rules in their absence. That’s why professional fees have been declining for two decades while facility fees climb. That’s why physicians have no ownership stake in hospitals and site-neutral payment remains an uphill fight. When you leave your seat at the table empty, someone else sits in it. 3. Physicians compete with each other instead of competing with the system. The surgeon across town is not the enemy. The health system extracting 40 to 60% of collections through facility fees is the enemy. The carrier dictating reimbursement rates with no negotiation leverage on the other side is the enemy. And physicians consistently choose to compete laterally, doctor against doctor, rather than collaborate and compete vertically against the institutions that actually control their economics. Every fragmented practice is easier to acquire, easier to underpay, and easier to ignore. 4. Ownership has been on the table. Physicians keep walking away from it. Physician-owned hospitals. Captive insurance vehicles. Joint ventures. Equity-bearing partnerships. Direct contracting. Employer-based clinics. The opportunities to own infrastructure, not just practice within it, have presented themselves repeatedly. And by every evidentiary account, physicians have taken a hard pass. Not because the models don’t work. Because the profession has been conditioned to trade autonomy for a paycheck, and most doctors have accepted those terms without reading the contract.​​​​​​​​​​​​​​​​ -Rojas out

@hjluks This is very on point as well. So many pts default mode is this passive helplessness and powerlessness. Maybe modern health care perpetuates that mindset.

The wear-and-tear model gives patients a passive role. Cartilage is gone, nothing to be done, wait for replacement. The biological model gives them an active one. The joint is struggling, the environment is fixable, and the tools are in your hands. That reframe can change everything about how people manage this disease. I have patients going on 10+ years with terrible looking X-rays. But they stay active, stay healthy and fit and tolerate it just fine. One day they might not tolerate it... then it's time for the surgery discussion. Not before then.

Osteoarthritis Of The Knee... Thread #1... of 4 "Bone on bone." "Your cartilage is worn away." "You have the knee of a 90 year old." I've heard these phrases bantered about thousands of times in 25 years. They are very common explanations patients get for their arthritic knee pain. They cause harm. Xray findings do not correlate with symptoms... they just don't. ... and those descriptions lead to decisions that might not be the proper treatment at that point in time. 🧵

@hjluks So true. I have run countless miles, marathons, triathlons, CrossFit on a knee with no ACL from age 18. My knee hurts but the pain I have is directly manageable with my diet and exercise. The cleaner I eat and the more I exercise the less it hurts.

Cartilage damage is present in OA, but cartilage doesn't have pain receptors. The pain comes from the bone, synovial lining, and surrounding tissues — all of which are affected by the inflammatory environment, not just by the structural loss. Addressing that environment changes pain. That's where treatment lives. And the inflammatory environment can be shaped by what is happening in the body the knee is attached to.

@hjluks The "bone on bone" one from pts makes my skin crawl.

@DougKass @TheStreetPro Doug, Enjoy your commentary so much I finally broke down and purchased The Street PRO so I can hear every day what you have to say. Thank you!

Today we will learn on the show that Weiss sold out of all his longs.... @thestreetpro @dougkass

@MichaelAlbertMD Really resonated with me. As an MD I realize that as I got older and had some of the same ailments and experiences as my patients, I was a MUCH better doctor. Big overlap in my career as an Addiction Medicine MD and Obesity medicine as well. Thanks for writing that.

I was most nervous about this piece. I honestly had no idea how it would be received. You all went crazy with it. I’m humbled by the interest and the positive discussions it’s sparked. substance-over-noise.beehiiv.com/p/special-edit…

@aliciaandrz It's prob not correct to say that they "end up" in such positions. That seems too passive. The question to me is what is it about sociopathy that drives them to pursue power? Until we can identify pathological would-be leaders not electing them this will continue.