Pain management and the opioid epidemic: balancing societal and individual benefits and risks of prescription opioid use.

Summary s-1 1 introduction 1-1 PART I Pain management and research 2 Pain management and the intersection of pain and opioid use disorder 2-1 • The scope of the problem of pain, 2-1 • Opioid analgesics, 2-4 • Nonopioid pharmacologic treatments, 2-16 • Interventional pain therapies, 2-25 • Nonpharmacologic treatments, 2-27 • Differences in pain experiences and treatment effectiveness among • Subpopulations, 2-33 • The intersection between pain and opioid use disorder, 2-36 • References, 2-36 3 Progress and future directions in research on pain and opioid use disorder 3-1 • Basic pain research, 3-1 • The neurobiology of the reward pathway and the intersection of pain and opioid • Use disorder, 3-10 • Preclinical and translational research, 3-13 • Clinical research, 3-18 • Intersection of pain and opioid use disorder, 3-26 • Support for research, 3-33 • Summary and recommendation, 3-34 • References, 3-34 PART II Addressing the opioid epidemic 4 Trends in opioid use, harms, and treatment 4-1 • Trends in prescription opioid use and misuse, 4-1 • Heroin use and its relation to prescription opioid use, 4-15 • Illicit opioid markets, 4-25 • The current state of surveillance systems, 4-32 • Recent developments in pharmaceutical treatment of opioid use disorder, 4-35 • Trends in treatment of opioid overdose with naloxone, 4-46 • Summary and recommendations, 4-48 • References, 4-49 5 Evidence on strategies for addressing the opioid epidemic 5-1 • Nature of the Evidence, 5-2 • The Need for a Systems Approach, 5-4 • Strategies for Restricting Supply, 5-10 • Strategies for Influencing Prescribing Practices, 5-21 • Strategies for Reducing Demand, 5-39 • Strategies for Reducing Harm, 5-46 • Summary and Recommendations, 5-58 • References, 5-60 6 Opioid approval and monitoring by the U.S. Food and drug administration 6-1 • Overview of the FDA’s regulatory process for prescription drugs and its application to opioids, 6-2 • Public health dimensions of FDA drug regulation, 6-17 • Key elements of an integrated decision-making framework for opioid • Regulation,6-22 • Implementation of an integrated framework for opioid regulation, 6-25 • Summary and recommendations, 6-40 • References, 6-44 • Annex table 6-1: extended-release(er)/long-acting (la) opioid post-marketing • Study requirements, 6-49 Appendixes A Data sources and methods a-1 B Biographical sketches of committee members and consultants b-1 C Existing data sources on opioid use, misuse, overdose, and other harms c-1 [Note: Download from NAP site if free, but may require guest registration with your email.]