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This eye-opening book richly documents disturbing trends in Western medicine and urges readers toward a broader understanding of drug use and abuse.
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.
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.
Examines OxyContin, the so-called miracle prescription drug that swept the nation but led to overdoes and addiction, providing a look at the multi-billion-dollar pain managment business, its excesses and its abuses.
“Hart’s argument that we need to drastically revise our current view of illegal drugs is both powerful and timely . . . when it comes to the legacy of this country’s war on drugs, we should all share his outrage.” —The New York Times Book Review From one of the world's foremost experts on the subject, a powerful argument that the greatest damage from drugs flows from their being illegal, and a hopeful reckoning with the possibility of their use as part of a responsible and happy life Dr. Carl L. Hart, Ziff Professor at Columbia University and former chair of the Department of Psychology, is one of the world's preeminent experts on the effects of so-called recreational drugs on the human mind and body. Dr. Hart is open about the fact that he uses drugs himself, in a happy balance with the rest of his full and productive life as a researcher and professor, husband, father, and friend. In Drug Use for Grown-Ups, he draws on decades of research and his own personal experience to argue definitively that the criminalization and demonization of drug use--not drugs themselves--have been a tremendous scourge on America, not least in reinforcing this country's enduring structural racism. Dr. Hart did not always have this view. He came of age in one of Miami's most troubled neighborhoods at a time when many ills were being laid at the door of crack cocaine. His initial work as a researcher was aimed at proving that drug use caused bad outcomes. But one problem kept cropping up: the evidence from his research did not support his hypothesis. From inside the massively well-funded research arm of the American war on drugs, he saw how the facts did not support the ideology. The truth was dismissed and distorted in order to keep fear and outrage stoked, the funds rolling in, and Black and brown bodies behind bars. Drug Use for Grown-Ups will be controversial, to be sure: the propaganda war, Dr. Hart argues, has been tremendously effective. Imagine if the only subject of any discussion about driving automobiles was fatal car crashes. Drug Use for Grown-Ups offers a radically different vision: when used responsibly, drugs can enrich and enhance our lives. We have a long way to go, but the vital conversation this book will generate is an extraordinarily important step.
As an adult book, Sam Quinones's Dreamland took the world by storm, winning the NBCC Award for General Nonfiction and hitting at least a dozen Best Book of the Year lists. Now, adapted for the first time for a young adult audience, this compelling reporting explains the roots of the current opiate crisis. In 1929, in the blue-collar city of Portsmouth, Ohio, a company built a swimming pool the size of a football field; named Dreamland, it became the vital center of the community. Now, addiction has devastated Portsmouth, as it has hundreds of small rural towns and suburbs across America. How that happened is the riveting story of Dreamland. Quinones explains how the rise of the prescription drug OxyContin, a miraculous and extremely addictive painkiller pushed by pharmaceutical companies, paralleled the massive influx of black tar heroin--cheap, potent, and originating from one small county on Mexico's west coast, independent of any drug cartel. Introducing a memorable cast of characters--pharmaceutical pioneers, young Mexican entrepreneurs, narcotics investigators, survivors, teens, and parents--Dreamland is a revelatory account of the massive threat facing America and its heartland.
NEW YORK TIMES BESTSELLER • A NEW YORK TIMES NOTABLE BOOK OF THE YEAR • A grand, devastating portrait of three generations of the Sackler family, famed for their philanthropy, whose fortune was built by Valium and whose reputation was destroyed by OxyContin. From the prize-winning and bestselling author of Say Nothing. "A real-life version of the HBO series Succession with a lethal sting in its tail…a masterful work of narrative reportage.” – Laura Miller, Slate The history of the Sackler dynasty is rife with drama—baroque personal lives; bitter disputes over estates; fistfights in boardrooms; glittering art collections; Machiavellian courtroom maneuvers; and the calculated use of money to burnish reputations and crush the less powerful. The Sackler name has adorned the walls of many storied institutions—Harvard, the Metropolitan Museum of Art, Oxford, the Louvre. They are one of the richest families in the world, but the source of the family fortune was vague—until it emerged that the Sacklers were responsible for making and marketing a blockbuster painkiller that was the catalyst for the opioid crisis. Empire of Pain is the saga of three generations of a single family and the mark they would leave on the world, a tale that moves from the bustling streets of early twentieth-century Brooklyn to the seaside palaces of Greenwich, Connecticut, and Cap d’Antibes to the corridors of power in Washington, D.C. It follows the family’s early success with Valium to the much more potent OxyContin, marketed with a ruthless technique of co-opting doctors, influencing the FDA, downplaying the drug’s addictiveness. Empire of Pain chronicles the multiple investigations of the Sacklers and their company, and the scorched-earth legal tactics that the family has used to evade accountability. A masterpiece of narrative reporting, Empire of Pain is a ferociously compelling portrait of America’s second Gilded Age, a study of impunity among the super-elite and a relentless investigation of the naked greed that built one of the world’s great fortunes.
Drug abuse persists as one of the most costly and contentious problems on the nation's agenda. Pathways of Addiction meets the need for a clear and thoughtful national research agenda that will yield the greatest benefit from today's limited resources. The committee makes its recommendations within the public health framework and incorporates diverse fields of inquiry and a range of policy positions. It examines both the demand and supply aspects of drug abuse. Pathways of Addiction offers a fact-filled, highly readable examination of drug abuse issues in the United States, describing findings and outlining research needs in the areas of behavioral and neurobiological foundations of drug abuse. The book covers the epidemiology and etiology of drug abuse and discusses several of its most troubling health and social consequences, including HIV, violence, and harm to children. Pathways of Addiction looks at the efficacy of different prevention interventions and the many advances that have been made in treatment research in the past 20 years. The book also examines drug treatment in the criminal justice setting and the effectiveness of drug treatment under managed care. The committee advocates systematic study of the laws by which the nation attempts to control drug use and identifies the research questions most germane to public policy. Pathways of Addiction provides a strategic outline for wise investment of the nation's research resources in drug abuse. This comprehensive and accessible volume will have widespread relevanceâ€"to policymakers, researchers, research administrators, foundation decisionmakers, healthcare professionals, faculty and students, and concerned individuals.
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.
Drugs, Addiction, and the Brain explores the molecular, cellular, and neurocircuitry systems in the brain that are responsible for drug addiction. Common neurobiological elements are emphasized that provide novel insights into how the brain mediates the acute rewarding effects of drugs of abuse and how it changes during the transition from initial drug use to compulsive drug use and addiction. The book provides a detailed overview of the pathophysiology of the disease. The information provided will be useful for neuroscientists in the field of addiction, drug abuse treatment providers, and undergraduate and postgraduate students who are interested in learning the diverse effects of drugs of abuse on the brain. - Full-color circuitry diagrams of brain regions implicated in each stage of the addiction cycle - Actual data figures from original sources illustrating key concepts and findings - Introduction to basic neuropharmacology terms and concepts - Introduction to numerous animal models used to study diverse aspects of drug use. - Thorough review of extant work on the neurobiology of addiction