Thread Reader

Stefan 🇺🇦 Kertesz, MD


Sep 19

21 tweets

1/Our study to examine suicides after Rx opioid reduction has been FUNDED   It’s called CSI:OPIOIDs-V We’ll look at suicides in Veterans & non-Veterans   Our outcome target is to help clinicians & healthcare organizations act to prevent these deaths

2/We are compelled to study these suicides because (a) they’re alarming, and (b) they occur as part of health care changes justified as being “for safety”

3/Our team of suicide, opioid & pain scholars chose a unique approach for this study 📖:psychological autopsy. I wish to explain why

4/Most studies of Rx opioid ⬇️ apply stats to calculate a “net” effect, as if the effects are *uniform*! 🤨   We know the the “net” effect is often “harm” But most of what explains why there are BAD outcomes, vs GOOD ones, is *unknown* - which we detail in @JAMA Network Open

5/The limitations to big database studies are clear:   ✅ By design, they factor OUT most differences between patients, and their life contexts, as *nuisance variables*   ✅Even if researchers wanted to look at these key factors, the retrospective databases don’t reveal them

6/To illustrate the *special* importance of looking at individual suicides, consider a comparison from a different domain: airplane crashes. In this video, I focus on the explosion of TWA Flight 800 in 1996

7/If we apply today’s opioid research methods to airplane✈️ crashes, we’d: ✅ make a database comparing ✈️ that stayed up to ✈️ that crashed, based on standard data for all ✈️ ✅We would NOT look at facts unique to crashes (“black boxes”) because they’re not available for all✈️s

8/But in the USA, when an ✈️crashes, investigators collect *every fact that can be gotten* about THAT crash. With TWA800, that led to safety recommendations

9/In the context of SUICIDE, by analogy, that kind of investigation is called “psychological autopsy” that combines interview & record review.  It has been used since 1963

10/Here are *some* of the MANY questions we can get at with psychological autopsy “How many shared concerns with family & friends?” “Was there an impasse in clinical care?” More in the pic

11/What other questions do YOU think we should ask?

12/ This work could protect future patients! But there are challenges to the work:   Ethical research requires voluntary recruitment of bereaved survivors There’s no public registry or database we can pull from   So we must *solicit the public*📢

13/ We have to do our best addressing distrust between survivors and both: a)    Healthcare b)    Researchers   We know researchers can be exploitative, not protective

14/ Transparency is essential. We’ve been transparent since our pilot study in 2020. Our detailed briefing is available on Youtube.

15/So how will CSI:OPIOIDS-V work? Many steps, simplified: ✅ Outreach ✅ A screening survey for people considering our study: ✅ A more detailed survey, an interview, and a medical record review with a subset Together, that’s psychological autopsy

16/We’ll report what we learn, as we learn it. Many, like @National Pain Advocacy Center & health care leaders are advisors   Together we WILL make recommendations We’ll submit our work to stringent peer review: we will NOT hide our findings We will maintain the strictest ethical standards.

17/ If you know someone:   A person who is a family member or CLOSE friend who lost someone to what might have been a suicide after prescription opioid reduction, Let them KNOW about us.

18/If you know an organization that has reach to bereaved survivors, let them know about us too! Reach out to them, and reach out to me in DM.

19/Our first major grant funding is from the Health Services Research & Development branch of the US Department of Veterans Affairs, and we received pilot funding from Krulak Marine Alliance of Alabama and Department of Medicine at @UAB. We thank all of them.

20/We are proud to partner, as well, with the Tragedy Assistance Program for Survivors @TAPS This is a leading nonprofit that cares for the families of America’s fallen heroes

TAPS provides comfort, care and resources to all those grieving the death of a military loved one.

Tragedy Assistance Program For Survivors (TAPS) Is Here For You!

21/We offer special thanks to the patients & families who told us how much this means to them. & to: April Hoge @Adam J. Gordon 🇺🇦🇺🇦🇺🇦 @UAB CAPPI @Allyson Varley @Megan McCullough @Anne Fuqua 🇺🇦 @National Pain Advocacy Center @Caitlin Wolford-Clevenger, Ph.D. @UAB Thomas Joiner, Yogesh Dwivedi, @Beth Darnall, PhD @VA HSR&D

Stefan 🇺🇦 Kertesz, MD


Physician/research in primary care, homelessness, addictions. Professor, UAB. Podcast: @OnHealer he/his Opinions=mine

Follow on Twitter