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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.
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.
"Opioids and Population Health: A Primer, will help senior undergraduate and graduate students to: 1. Describe theories of addiction. 2. Demonstrate the differences between substance abuse prevention, intervention, and treatment. 3. Explain the United States' historical response to opioids. 4. Discuss the differential scope and burden of the current opioid and heroin epidemic on communities and populations. 5. Explain the various sectors, government agencies, and institutions that address addiction generally and the opioid/heroin epidemic specifically. 6. Describe the effectiveness of policy, legal, and regulatory approaches currently in use to address the epidemic. 7. Consider recommendations for sustainable policy and systems changes that are needed to change the opioid addiction trajectory and reduce the epidemic. The text is written through an interdisciplinary approach using the fields of public health, addiction health services research, and implementation science. The authors' experiences with direct client services, city, county, and state governments, managing non-profits, and evaluating treatment interventions speaks to their ability to address issues related to the epidemic thoroughly and critically"--
The American Opioid Epidemic: From Patient Care to Public Health provides practicing psychiatrists, trainees, and other mental health professionals with the latest information on opioid addiction, including misuse of heroin and other illicit opioids, the role of prescription analgesic opioids, and recent overdose trends. Although highly effective in relieving acute pain, opioids can cause untold damage to people's lives, health, and social structures. Recognizing the efficacy of these drugs when prescribed appropriately, the editors call not for eliminating access or for incarcerating those who are addicted, but for changing the patterns of prescribing and use. The crisis is analyzed by expert contributors from a wide variety of perspectives, they address issues of epidemiology and toxicology, prevention and harm reduction, and common comorbidities. Stressing that prevention and treatment do work, expert contributors provide down-to-earth, public-health-focused strategies that clinicians and public health workers alike will find indispensable. Moreover, the use of clinical vignettes and key chapter points help ground the reader and highlight the most important concepts. -- Publisher.
An incisive, essential guide to understanding one of today's most urgent -- and complex -- problems. The Opioid Epidemic: What Everyone Needs to Know® is an accessible, nonpartisan overview of the causes, politics, and treatments tied to the most devastating health crisis of our time. Its comprehensive approach and Q&A format offer readers a practical path to understanding the epidemic from all sides. Written by two expert physicians and enriched with stories from their experiences on the front lines of this epidemic, this book is a critical resource for any general reader -- and for the individuals and families fighting this fight in their own lives.
Offering timely guidance on the junction of the opioid crisis and infectious diseases, this practical handbook by Dr. Brianna L. Norton provides concise yet comprehensive coverage of a growing patient population. Infectious disease specialists are increasingly seeing patients who previously used opiods and now use intravenous drugs. Many challenges are unique to this patient population, including new and growing infections such as hepatitis C, endocarditis, HIV, and hepatitis B. The Opioid Epidemic and Infectious Diseases is an up-to-date, real-world guide that covers the scope of the problem, management guidelines, and much more. - Describes the new landscape of the opioid crisis in the U.S. and its intersection with infectious diseases, including epidemiology, Opioid Use Disorder (OUD) and rural America, and more. - Offers practical guidance on (OUD) and infectious co-morbidities like hepatitis C, STDs, endocarditis, HIV, and hepatitis B. - Covers prevention, treatment, and harm reduction. - Discusses OUD, infectious diseases, and the criminal justice system. - Consolidates today's available information and guidance into a single, convenient resource.
POPULATION HEALTH SCIENCE formalizes an emerging discipline at the crossroads of social and medical sciences, demography, and economics--an emerging approach to population studies that represents a seismic shift in how traditional health sciences measure and observe health events. Bringing together theories and methods from diverse fields, this text provides grounding in the factors that shape population health. The overall approach is one of consequentialist science: designing creative studies that identify causal factors in health with multidisciplinary rigor. Distilled into nine foundational principles, this book guides readers through population science studies that strategically incorporate: · macrosocial factors · multilevel, lifecourse, and systems theories · prevention science fundamentals · return on investment · equity and efficiency Harnessing the power of scientific inquiry and codifying the knowledge base for a burgeoning field, POPULATION HEALTH SCIENCE arms readers with tools to shift the curve of population health.
A comprehensive portrait of a uniquely American epidemic -- devastating in its findings and damning in its conclusions The opioid epidemic has been described as "one of the greatest mistakes of modern medicine." But calling it a mistake is a generous rewriting of the history of greed, corruption, and indifference that pushed the US into consuming more than 80 percent of the world's opioid painkillers. Journeying through lives and communities wrecked by the epidemic, Chris McGreal reveals not only how Big Pharma hooked Americans on powerfully addictive drugs, but the corrupting of medicine and public institutions that let the opioid makers get away with it. The starting point for McGreal's deeply reported investigation is the miners promised that opioid painkillers would restore their wrecked bodies, but who became targets of "drug dealers in white coats." A few heroic physicians warned of impending disaster. But American Overdose exposes the powerful forces they were up against, including the pharmaceutical industry's coopting of the Food and Drug Administration and Congress in the drive to push painkillers -- resulting in the resurgence of heroin cartels in the American heartland. McGreal tells the story, in terms both broad and intimate, of people hit by a catastrophe they never saw coming. Years in the making, its ruinous consequences will stretch years into the future.
Getting Wrecked provides a rich ethnographic account of women battling addiction as they cycle through jail, prison, and community treatment programs in Massachusetts. As incarceration has become a predominant American social policy for managing the problem of drug use, including the opioid epidemic, this book examines how prisons and jails have attempted concurrent programs of punishment and treatment to deal with inmates struggling with a diagnosis of substance use disorder. An addiction physician and medical anthropologist, Kimberly Sue powerfully illustrates the impacts of incarceration on women’s lives as they seek well-being and better health while confronting lives marked by structural violence, gender inequity, and ongoing trauma.
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.