@LNelsonMD

Emergency Medicine, Medical Toxicology, Addiction Medicine. Pain Medicine. The dose makes the poison.

Joined March 2014
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13Media
An impassioned story of a tragic loss compounded by misinformation and contempt. This commentary could not have been more spot on. Opinion | The Nonsense Over Secondhand Fentanyl Overdoses Must End - nytimes.com/2024/08/04/opini… @acmtmedtox @toxicologist12 @JMPerroneMD

Opinion | After My Brother’s Overdose Death, Misinformed People Added to Our Grief (Published 2024)

You cannot overdose on fentanyl by touching a person who overdosed.

nytimes.com
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Xylazine Adulteration of the Heroin–Fentanyl Drug Supply: A Narrative Review: Annals of Internal Medicine: Vol 0, No 0 @JMPerroneMD @LNelsonMD @HarozR and Rachel Wightman. acpjournals.org/doi/10.7326/…

Xylazine Adulteration of the Heroin–Fentanyl Drug Supply: A Narrative Review: Annals of Internal...

Xylazine is an animal sedative, approved by the U.S. Food and Drug Administration, that is commonly used in veterinary medicine and is not approved for human use. Since 2016, xylazine has consisten...

acpjournals.org
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Amazing insight from @JMPerroneMD highlighting misconceptions of xylazine risk and the damage caused by stigmatization of substance use. @ASAMorg @acmtmedtox @JLoveMD @RutgersTox @JDOrazioMD #xylazine inquirer.com/opinion/comment…

We’re talking about fentanyl and xylazine all wrong

Rather than stigmatizing people living with addiction, the most important thing we can do is encourage and support people in their journey to recovery.

inquirer.com
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Even though we like their product, they are still just a business. Trying to convince regulators that bup tablets were not safe but their new strips were so as to prevent generic tablets from staying on the market is anticompetitive. npr.org/2023/06/02/117975705…

Addiction drug maker will pay more than $102 million fine for stifling competition

Indivior was accused of using illegal strategies to keep generic versions of the opioid-treatment medication Suboxone off the market. The company denies wrongdoing.

npr.org
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Agree. In fact, I've generally thought it's great that the precipitated withdrawal from naloxone is so short lived...
Andrew Stolbach, MD, MPH@toxicologist1225 May 2023
Naloxone is short acting. That’s a good thing. Withdrawal will pass quickly. When naloxone wears off, we can give more if we need to. I have been treating opioid overdoses for nearly two decades, and I have never, ever thought we needed a long-acting reversal agent.
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What the officers and others experience is real to them. The issue is with the messaging and the reporting. njspotlightnews.org/special-… @acmtmedtox @toxicologist12 @JMPerroneMD

Fentanyl myth: Police cry overdose, facts prove otherwise - NJ Spotlight News

Medical experts decry claims of dangerous fentanyl exposure, trend started in New Jersey

njspotlightnews.org
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I guess it depends what "less than" means? $49.99 is not going to be good (cheap) enough. @JMPerroneMD @acmtmedtox @toxicologist12 @DrDianeC nbcnews.com/health/health-ne…

Over-the-counter Narcan to cost less than $50 for a two-pack, company says

The opioid overdose reversal drug will be available without a prescription later this year, but experts fear the price could be too high.

nbcnews.com
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Well done. Words frame our perception, and perception allows us to choose our words. Changing either is hard especially when the consequences are overlooked or minimized. bit.ly/3N909hZ @ASAM @JMPerroneMD @emupdates @kathryn_hawk

When it comes to addiction, Americans’ word choices are part of the problem

“Words matter tremendously, and much of the language we use when we talk about addiction is very dissimilar from the language we use for other health conditions."

statnews.com
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A thoughtful and inspiring story with a wonderful perspective about why opioids are not the answer to chronic pain (read the comments too). medpagetoday.com/opinion/rev…

Opinion | Every Day, I Live My Life in Pain

Milton Packer considers the origins of pain, both scientifically and emotionally

medpagetoday.com
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Today, internal records of Mallinckrodt, the largest opioid maker at the height of the prescription pill crisis, have been made public, a first-of-its-kind release to come from years-long litigation over the drug epidemic. Here’s a look at the documents: wapo.st/3M2o0OV

Inside the sales machine of the ‘kingpin’ of opioid makers

More than a quarter of top prescribers ranked by Mallinckrodt Pharmaceuticals during the height of the pain pill epidemic, in 2013, were later convicted of crimes related to their medical practices,...

washingtonpost.com
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Although there were misinterpretations of the 2016 CDC opioid guidelines, it is unfortunate when info is quoted out of context. See refs 1-4: do these "enforcement actions" have anything to do with the guidelines? (no: doctor shopping, pill mills, etc) natlawreview.com/article/rev…

Revised CDC Guidance for Prescribing Opioids Emphasizes Physician Judgment, Reflects Concerns About...

Conscientious medical providers face difficult tradeoffs when deciding whether to prescribe opioid medications to treat patients with chronic pain. For patients who have failed other therapies,...

natlawreview.com
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Another unfortunate misleading story about fentanyl exposure. wkrn.com/news/local-news/lor… The officer rightly thought what happened was real. But we know it is the nocebo effect not poisoning, and still very real. statnews.com/2018/12/21/pass… @JMPerroneMD @acmtmedtox @toxicologist12
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In the spirit of holiday fun, what can we learn from this story? A. Babies are immune to fentanyl B. You can drive under the influence of opioids if you are an officer C. Narcan can be used as a verb ​(narcanned) D. Counterfeit prescription opioids can contain fentanyl (Ans: D)
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The irrationality of dealing with fentanyl (non)-exposure. Who is making these decisions? Do reporters do any background? @acmtmedtox @toxicologist12 @JMPerroneMD Sequoyah High School student in custody after fentanyl found | WATE 6 On Your Side wate.com/news/sequoyah-high-…

Sequoyah High School student in custody after fentanyl found

A Sequoyah High School student is in custody after fentanyl was found on school grounds Tuesday, a Monroe County Sheriff’s Office spokesperson said.

wate.com
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A fairly comprehensive catalog of opportunities available through HHS to address SUD/OUD. Worth some of your time to review. hhs.gov/overdose-prevention/… @opioidsCOBRE @JMPerroneMD @emupdates @HarozR @acmtmedtox

Overdose Prevention

Overdose Prevention

hhs.gov
Not to forget either that going from a 0.4 to 5 mg dose will put a further strain on the troubled naloxone supply chain. theguardian.com/us-news/2021…

Price for drug that reverses opioid overdoses soars amid record deaths

Pfizer manufacturing problems leave nonprofits paying exorbitant prices for dwindling supplies of life-saving naloxone

theguardian.com
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This is misguided and shows a lack of understanding about opioid (and specifically fentanyl) overdose and naloxone. fda.gov/drugs/news-events-hu…

FDA approves naloxone injection to counteract opioid overdoses

FDA approves ZIMHI (naloxone hydrochloride) injection as an additional option to treat opioid overdose.

fda.gov
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pink.pharmaintelligence.info…
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The NYT piece highlights why this is not possibly fentanyl intoxication. The officer was clearly deeply affected (nocebo effect) but not poisoned. Some reasons detailed here bit.ly/3lIhmTv nyti.ms/3fGPQ50

'Passive' fentanyl exposure: more myth than reality

Hyperbolic warnings and burdensome recommendations for avoiding passive exposure to fentanyl may interfere with the ability of first responders and others to do their jobs.

statnews.com
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I feel bad for this officer, who had experienced some kind of medical event (syncope? anxiety?). I am embarrassed for fellow emergency workers that this episode was made into a slickly produced infomercial for medical hysteria and bad science. Fentanyl doesn’t work like this!
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