Pain Management And The Opioid Epidemic

Drug overdose, driven largely by overdose related to the use of opioids, is now the leading cause of unintentional injury death in the United States. The ongoing opioid crisis lies at the intersection of two public health challenges: reducing the burden of suffering from pain and containing the rising toll of the harms that can arise from the use of opioid medications. Chronic pain and opioid use disorder both represent complex human conditions affecting millions of Americans and causing untold disability and loss of function. In the context of the growing opioid problem, the U.S. Food and Drug Administration (FDA) launched an Opioids Action Plan in early 2016. As part of this plan, the FDA asked the National Academies of Sciences, Engineering, and Medicine to convene a committee to update the state of the science on pain research, care, and education and to identify actions the FDA and others can take to respond to the opioid epidemic, with a particular focus on informing FDA's development of a formal method for incorporating individual and societal considerations into its risk-benefit framework for opioid approval and monitoring.

Drug overdose, driven largely by overdose related to the use of opioids, is now the leading cause of unintentional injury death in the United States. The ongoing opioid crisis lies at the intersection of two public health challenges: reducing the burden of suffering from pain and containing the rising toll of the harms that can arise from the use of opioid medications. Chronic pain and opioid use disorder both represent complex human conditions affecting millions of Americans and causing untold disability and loss of function. In the context of the growing opioid problem, the U.S. Food and Drug Administration (FDA) launched an Opioids Action Plan in early 2016. As part of this plan, the FDA asked the National Academies of Sciences, Engineering, and Medicine to convene a committee to update the state of the science on pain research, care, and education and to identify actions the FDA and others can take to respond to the opioid epidemic, with a particular focus on informing FDA's development of a formal method for incorporating individual and societal considerations into its risk-benefit framework for opioid approval and monitoring.

The opioid crisis in the United States has come about because of excessive use of these drugs for both legal and illicit purposes and unprecedented levels of consequent opioid use disorder (OUD). More than 2 million people in the United States are estimated to have OUD, which is caused by prolonged use of prescription opioids, heroin, or other illicit opioids. OUD is a life-threatening condition associated with a 20-fold greater risk of early death due to overdose, infectious diseases, trauma, and suicide. Mortality related to OUD continues to escalate as this public health crisis gathers momentum across the country, with opioid overdoses killing more than 47,000 people in 2017 in the United States. Efforts to date have made no real headway in stemming this crisis, in large part because tools that already existâ€"like evidence-based medicationsâ€"are not being deployed to maximum impact. To support the dissemination of accurate patient-focused information about treatments for addiction, and to help provide scientific solutions to the current opioid crisis, this report studies the evidence base on medication assisted treatment (MAT) for OUD. It examines available evidence on the range of parameters and circumstances in which MAT can be effectively delivered and identifies additional research needed.

The United States is facing an opioid use disorder epidemic with opioid overdoses killing 47,000 people in the U.S. in 2017. The past three decades have witnessed a significant increase in the prescribing of opioids for pain, based on the belief that patients were being undertreated for their pain, coupled with a widespread misunderstanding of the addictive properties of opioids. This increase in prescribing of opioids also saw a parallel increase in addiction and overdose. In an effort to address this ongoing epidemic of opioid misuse, policy and regulatory changes have been enacted that have served to limit the availability of prescription opioids for pain management. Overlooked amid the intense focus on efforts to end the opioid use disorder epidemic is the perspective of clinicians who are experiencing a significant amount of daily tension as opioid regulations and restrictions have limited their ability to treat the pain of their patients facing serious illness. Increased public and clinician scrutiny of opioid use has resulted in patients with serious illness facing stigma and other challenges when filling prescriptions for their pain medications or obtaining the prescription in the first place. Thus clinicians, patients, and their families are caught between the responses to the opioid use disorder epidemic and the need to manage pain related to serious illness. The National Academies of Sciences, Engineering, and Medicine sponsored a workshop on November 29, 2018, to examine these unintended consequences of the responses to the opioid use disorder epidemic for patients, families, communities, and clinicians, and to consider potential policy opportunities to address them. This publication summarizes the presentations and discussions from the workshop.

Acute Pain Medicine is the first comprehensive, case-based text of its kind that explores the essential topics of acute pain medicine, including interventional, pharmacologic, and diagnostic considerations. Written and edited under the auspices of the American Academy of Pain Medicine by members of the Academy's Shared Interest Group for Acute Pain Medicine, the text includes an introduction to acute pain medicine and an easily referenced interventional section. Chapters focus on patients experiencing acute pain from either surgery or other medical conditions and include detailed information on the diagnosis and treatment of specific cases in acute pain medicine. The text is rounded out by the complete content of the thoroughly revised Military Advanced Regional Anesthesia and Analgesia Handbook (MARAA II). Although the MARAA handbook gained its reputation as a useful resource for managing the pain associated with battlefield trauma, its beautifully illustrated step-by-step guidance is useful for providing vital acute pain services in all settings. Acute Pain Medicine is an ideal, complete resource for physicians, fellows, and residents managing acute pain patients.

Fighting the Opioid Epidemic: The Role of Providers and the Clinical Laboratory in Understanding Who Is Vulnerable covers the important aspects that are essential in fighting the opioid epidemic. This succinct reference highlights how the toxicology laboratory can play a vital role in fighting the opioid epidemic by implementing a robust system for drugs of abuse testing as well as drug testing in pain management patients. It targets health care professionals in a technical manner, discussing polymorphisms of important genes that may be associated with increased vulnerability of alcohol and drug addiction to an individual. Covers all important aspects of opioid abuse, including genetic and environmental factors Discusses pharmacology, toxicology and the pharmacogenomics related to opioid metabolism Presents genetic and environmental factors associated with those vulnerable to opioid addiction, as well as the pitfalls of drug testing in pain management

The opioid overdose epidemic combined with the need to reduce the burden of acute pain poses a public health challenge. To address how evidence-based clinical practice guidelines for prescribing opioids for acute pain might help meet this challenge, Framing Opioid Prescribing Guidelines for Acute Pain: Developing the Evidence develops a framework to evaluate existing clinical practice guidelines for prescribing opioids for acute pain indications, recommends indications for which new evidence-based guidelines should be developed, and recommends a future research agenda to inform and enable specialty organizations to develop and disseminate evidence-based clinical practice guidelines for prescribing opioids to treat acute pain indications. The recommendations of this study will assist professional societies, health care organizations, and local, state, and national agencies to develop clinical practice guidelines for opioid prescribing for acute pain. Such a framework could inform the development of opioid prescribing guidelines and ensure systematic and standardized methods for evaluating evidence, translating knowledge, and formulating recommendations for practice.

The current opioid epidemic in the United States began in the mid-1990s with the introduction of a new drug, OxyContin, viewed as a safer and more effective opiate for chronic pain management. By 2017, the opioid epidemic had become a full-blown crisis as over two million Americans had become dependent on and abused prescription pain pills and street drugs. This book examines the origins, development, and rise of the opioid epidemic in the United States from the perspective of the public policy process. The authors, political scientists Kant Patel and Mark Rushefsky, discuss institutional features of the American political system that impact the making of public policy, arguing that the fragmentation of that system hinders the ability to coherently address policy problems, taking the opioid epidemic as an example. The book begins with a brief historical examination of the history of the problem of opioid addiction and crises in the United States and public policy responses to past crises, but the main focus is on the current national public health emergency. The book analyzes the following: The origins of the current crisis Indicators and warning signs pointing to the emergence of a significant public problem Factors that contributed to the opioid crisis Why the crisis emerged in the United States and not in other Western countries The nature and scope of the opioid crisis, including socioeconomic and demographic characteristics and the human, social, and economic costs Presidential administrations’ public response, and nonresponse, to the opioid crisis Parallels between the role played by opioid manufacturers and tobacco/cigarette manufacturers in creating the problem of addiction, resulting in high mortality rates, and the public policy response to both This book explores the national policy response to the opioid crisis, as well as state and local government responses and separation of powers, including how the three branches of government deal with the opioid problem. The authors conclude with a discussion of how accurate problem definition, problem diagnosis, and appropriate and timely responses could have produced a more appropriate and robust policy response—policy process tools that will be essential in fighting both the current crisis and the next one. The Opioid Epidemic in the United States is essential reading for policy analysis courses in political science, health, and social work programs, as well as for United States policymakers at the local, state, and national levels.