Andrea Rubinstein

A rare opportunity for LCSW/MFT to join a world class multidisciplinary pain team that includes MD/PT/RN/PharmD psychologist/ acupuncture in the heart of the California Wine country with Kaiser Permanente. DM me

@UCDavisPain @UCDavisHealth @UCDavis_CAPR @ScottPritzlaff @RaviPrasadPhD @RNalamasuDO @sjsheth1204 I have had the privilege and honor of co-leading a talk with Rebecca Hoss for @ucdavis train the trainer program. She is nothing short of amazing and a huge asset to the UC Davis Pain Program. S

Monday #ShoutOut to @UCDavisHealth #Pharmacy extraordinaire, Dr. Rebecca Hoss! Dr. Hoss is an invaluable resource for the @UCDavisPain fellows as they learn about #buprenorphine on their Pain & Opioid Stewardship rotation. @UCDavis_CAPR @UCDavisHealth #painfellowship

DHL sucks. My package went Paris to San Francisco in 3 days. Now it has been In Francisco for 10 days. They are awful on the phone horrible. But they did tell me if the package is a wedding dress or documents they will get it to me tomorrow. Otherwise it is the 11th.

My peoples, the time has come for a MEGATHREAD. In 40 tweets I will explain another 40 concepts you should know. Strap in. Here we go:

If you live in #CathedralCity you might be interested to know your city council woman Rita Lamb just had her 4th property busted for illegal cannabis cultivation in the high desert.

Thread: It’s incredibly tragic that so many physicians in addiction medicine are more afraid of the DEA, policies, and other things instead of thinking outside the box by doing and prescribing the appropriate things to truly help their patients.

@DrMelissaWeimer @suenlw @CarolynAChan @leyde_sarah @AMERSA_tweets @StefanKertesz I guess i am confused about the advantages of methadone, a QT prolonging opioid with multiple half lives and complex pharmacokinetics over virtually any other opioid as a bridge to being opioid free

@DrMelissaWeimer @suenlw @CarolynAChan @leyde_sarah @AMERSA_tweets @StefanKertesz Methadone may make it easier to get off a fentanyl drip, but my no means are they off opioids at discharge if they are discharged on methadone. How now do they get off methadone?

@Loura_Stories @davidthekick @deedeestoutHRR Actually buprenorphine was developed in the 1960’s for pain. It was only reluctantly brought to market to treat opioid use disorder.

@rubinsteinmd @davidthekick @deedeestoutHRR Bupe was never intended as a long-term care med. It was made exclusively to help wean people clean of all opiates, based on the original studies from Indivior. But it really rakes in the $$ when people are hooked on it for life. @fuckthat/does-buprenorphine-really-save-lives-8b468337599" target="_blank" rel="nofollow noopener">medium.com/@fuckthat/does…

I can get #heroin mailed to my house overnight, but it takes two weeks to get into a #methadone clinic, and 60% of US counties do not have a physician licensed to prescribe #Buprenorphine. What does that say about our #harmreduction system?

@Loura_Stories @davidthekick @deedeestoutHRR Actually the brain cant tell whether the opioid you use was obtained legally or illegally. I work with patients who have been prescribed opioids for many years and work to get them off. Many do get off but some just can’t. For these people buprenorphine is often the best.

@rubinsteinmd @davidthekick @deedeestoutHRR Where is your citation for this claim? I think you mean “people addicted to illegal drugs” can have their brains permanently altered, not grandpa veterans treating their war wounds.

@Loura_Stories @davidthekick @deedeestoutHRR Also, the definition of addiction is 1. Inability to control, use, 2. Continued use despite adverse consequence. Using buprenorphine as prescribed is neither of these. Physical dependence does not equal addiction.

@davidthekick @deedeestoutHRR Do you know what I and most people take to avoid heroin? Nothing. We simply don’t take heroin. Heroin does not treat a medical condition. @fuckthat/does-buprenorphine-really-save-lives-8b468337599" target="_blank" rel="nofollow noopener">medium.com/@fuckthat/does…

@HillPharmD @AACPharmacy In the non-fee for service world, we rely heavily on PharmDs to do a myriad of essential patient care. From tapering opioids to managing Coumadin, osteoporosis and so much more. This is 21st century medicine.

@ACLakeMD I have wondered this too. My neighbor, who has lymphoma and AIDs said that within the HIV community they are not seeing as much COVID as they would have expected. Not an expert in this area at all, just interesting.

I know we typically worry the most about immunocompromised people when it comes to infections. But I have to say, with COVID I haven’t seen this play out. I am starting to think the immune system *is* the problem. Can someone shoot me down already?

This is wonderful. Everyone who cares for patients who have an opioid use disorder really needs to be able to prescribe buprenorphine for the appropriate patient. #buprenorphine #primarycare #MedTwitter

@StefanKertesz Amen. Next year.... anywhere and I am good.

Amen

@StefanKertesz California has eased rules on methadone and buprenorphine treatment allowing telephone or video visit in place of in person visit for the start of these medications.

It can be hard to to keep people alive if you cannot _treat them_. Normally, methadone clinics starting treatment must do an in-person physical exam. But these are not normal times. The regulation should be flexed, with caution, but flexed.

@rpjpac @JeffreyFudin This is not our experience at all. We find that if we just ask “hey would you like to reduce your dose if we could do it comfortably and without increasing pain or decreasing function (which we can) over. 90% of patients say “sure.”

@rubinsteinmd @JeffreyFudin From my experience, very few, maybe postoperative patients requesting reduction, but clinicians must evaluate QOL, function and ADLs and treat accordingly. Working hand in hand with a Pharm to change opiates or offer a step down recommendation would work to lessen the fear.

Pharmacists are VERY capable of direct patient care and GROSSLY underutilized. Give pharmacists provider status so they can participate and bill third party payers. #rebrandphramcy

@rpjpac @JeffreyFudin Why taper? Or why have pharmacist do it? Our tapers are patient driven and are not arbitrary. Many people want to lower their doses if they can achieve good pain control with fewer risk and side effects. Pharmacists are perfect for this.

@rubinsteinmd @JeffreyFudin Tapers!? Really? Why?

@rpjpac @JeffreyFudin As chief of a department of pain medicine, I can say I depend on my clinical pharmacist daily as does the rest of our team. Our patients really like working with him and he handles the vast majority of our opioid tapers.

@JeffreyFudin Unless they did extensive clinical work, they just don't have that necessary knowledge. Only those PharmDs with CP understand.