1/I'm excited that Dr. @AjayManhapra is presenting on concerns about mandatory opioid taper for VA's MAT-VA journal club, based on our shared paper... he notes Human costs of mandatory and widespread opioid taper

2/He cites @BethDarnall as the best available study, noting that even when one offers the best support system, a significant % of patients do not have a reduction in pain or pain worsens.

3/In a way that will seem controversial, he proposes that opioid therapy is not exactly an analgesic. This is daily use of an addictive substance that offers relief, where only a minority develop addiction.

4/I should caution that @AjayManhapra is far from a "fan" of opioids for pain. Many people on them do not get benefit, he says. My reading of same data is more favorably disposed, even though we collaborate

5/There is an "opponent effect" so that relief from opioids is also opposed - not in all people and to the same degree - but this is part of the dependence dilemma for some persons at high dose