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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.
This book offers expert, balanced, concise guidance on how clinicians can navigate a number of complex considerations to formulate a treatment plan for chronic pain that either includes or advisedly excludes opioids.
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.
"These guidelines were produced by the World Health Organization (WHO), Department of Mental Health and Substance Abuse, in collaboration with the United Nations Office on Drugs and Crime (UNODC) a Guidelines Development Group of technical experts, and in consultation with the International Narcotics Control Board (INCB) secretariat and other WHO departments. WHO also wishes to acknowledge the financial contribution of UNODC and the Joint United Nations Programme on HIV/AIDS (UNAIDS) to this project. " - p. iv
The Drug Expert: A Practical Guide to the Impact of Drug Use in Legal Proceedings targets academic and industry pharmacologists, pharmacology graduate students, and professionals and students of affiliated disciplines, such as pharmacy and toxicology. Users will find it to be an invaluable reference for those involved in the field. In addition, pharmacists and others who increasingly serve as expert witnesses and toxicologists will find an array of very useful information. - Focuses on important topics for the consulting pharmacologist, including prescription, over-the-counter and illegal drugs and their effects on criminal and civil proceedings - Details the "how-to aspects of being an expert witness in pharmacology by presenting real-life cases and effective tips and experiences - Includes several appendices, such as a sample letter of engagement and fee schedule, a litigation report, a consulting invoice and valuable resources
Chronic pain costs the nation up to $635 billion each year in medical treatment and lost productivity. The 2010 Patient Protection and Affordable Care Act required the Department of Health and Human Services (HHS) to enlist the Institute of Medicine (IOM) in examining pain as a public health problem. In this report, the IOM offers a blueprint for action in transforming prevention, care, education, and research, with the goal of providing relief for people with pain in America. To reach the vast multitude of people with various types of pain, the nation must adopt a population-level prevention and management strategy. The IOM recommends that HHS develop a comprehensive plan with specific goals, actions, and timeframes. Better data are needed to help shape efforts, especially on the groups of people currently underdiagnosed and undertreated, and the IOM encourages federal and state agencies and private organizations to accelerate the collection of data on pain incidence, prevalence, and treatments. Because pain varies from patient to patient, healthcare providers should increasingly aim at tailoring pain care to each person's experience, and self-management of pain should be promoted. In addition, because there are major gaps in knowledge about pain across health care and society alike, the IOM recommends that federal agencies and other stakeholders redesign education programs to bridge these gaps. Pain is a major driver for visits to physicians, a major reason for taking medications, a major cause of disability, and a key factor in quality of life and productivity. Given the burden of pain in human lives, dollars, and social consequences, relieving pain should be a national priority.
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.
Why medication-assisted treatment, the most effective tool for battling opioid addiction, is significantly underused in the United States. Bronze Winner of the 2021 IPPY Book Award in Health/Medicine/Nutrition, Gold Winner of the 2020 Foreword INDIES Award in Health America's addiction crisis is growing worse. More than 115 Americans die daily from opioid overdoses, with half a million deaths expected in the next decade. Time and again, scientific studies show that medications like Suboxone and methadone are the most reliable and effective treatment, yet more than 60 percent of US addiction treatment centers fail to provide access to them. In The Opioid Fix, Barbara Andraka-Christou highlights both the promise and the underuse of medication-assisted treatment (MAT). Addiction, Andraka-Christou writes, is a chronic medical condition. Why treat it, then, outside of mainstream medicine? Drawing on more than 100 in-depth interviews with people in recovery, their family members, treatment providers, and policy makers, Andraka-Christou reveals a troubling landscape characterized by underregulated treatment centers and unnecessary ideological battles between twelve-step support groups and medication providers. The resistance to MAT—from physicians who won't prescribe it, to drug courts that prohibit it, to politicians who overregulate it—showcases the narrow-mindedness of the system and why it isn't working. Recounting the true stories of people in recovery, this groundbreaking book argues that MAT needs to be available to anyone suffering from opioid addiction. Unlike other books about the opioid crisis, which have largely focused on causal factors like pharmaceutical overprescription and heroin trafficking, this book focuses on people who have already developed an opioid addiction but are struggling to find effective treatment. Validating the experience of hundreds of thousands of Americans, The Opioid Fix sounds a loud call for policy reforms that will help put lifesaving drugs into the hands of those who need them the most.
All across the United States, individuals, families, communities, and health care systems are struggling to cope with substance use, misuse, and substance use disorders. Substance misuse and substance use disorders have devastating effects, disrupt the future plans of too many young people, and all too often, end lives prematurely and tragically. Substance misuse is a major public health challenge and a priority for our nation to address. The effects of substance use are cumulative and costly for our society, placing burdens on workplaces, the health care system, families, states, and communities. The Report discusses opportunities to bring substance use disorder treatment and mainstream health care systems into alignment so that they can address a person's overall health, rather than a substance misuse or a physical health condition alone or in isolation. It also provides suggestions and recommendations for action that everyone-individuals, families, community leaders, law enforcement, health care professionals, policymakers, and researchers-can take to prevent substance misuse and reduce its consequences.