IntellaRx
Insights
Notes on the opioid crisis, prescribing policy and the evidence behind them — written for the people who have to make decisions about it.
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Language and the opioid debate
Several terms in constant use in this field are not what they appear to be, including one in our own founding material.
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What positive identification is actually for
We could not find evidence for the usual justification, so here is the one that survives contact with the data.
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Presumptive is not positive
The single rule that prevents most documented harm from drug testing, and why it is broken so often.
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Absence of evidence is not evidence of absence — and not evidence of effect either
The AHRQ finding on risk mitigation is stranger than “the evidence is weak,” and it applies to most of the standard toolkit.
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Observational evidence, and what to do with it
All the strongest evidence on tapering harm is observational. That is a real limitation and it is not a reason to ignore it.
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What a well-run taper looks like
The evidence against rapid, mandated tapering is not an argument that nobody should ever reduce a dose. It is an argument about how, and about who decides.
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Base rates and outlier flags
When the behavior you are screening for is rare, most of what you flag will be something else. This is arithmetic, not a criticism of anyone’s analytics.
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The 2024 decline, and what we do not know about it
Opioid overdose deaths fell by roughly a third in two years. It is the best news in twenty years and nobody can fully explain it.
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What population trends can and cannot tell you
Two things moving at the same time in national data is almost never enough to establish that one caused the other — in either direction.
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What a prescribing limit actually does
A limit is not a weaker version of clinical judgment. It is a different instrument with different failure modes, and it is worth being precise about them.
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How to read a prevalence figure
Prevalence, incidence and persistence answer different questions, and policy written against the wrong one comes out mis-sized.
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What IntellaRx is, in one page
The whole program in about six hundred words, for someone who has been handed a link and has four minutes.