Pain Management and the Opioid Epidemic

Pain Management and the Opioid Epidemic
Author: National Academies of Sciences, Engineering, and Medicine,Health and Medicine Division,Board on Health Sciences Policy,Committee on Pain Management and Regulatory Strategies to Address Prescription Opioid Abuse
Publsiher: National Academies Press
Total Pages: 482
Release: 2017-09-28
Genre: Medical
ISBN: 9780309459570

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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.

Fighting the Opioid Epidemic

Fighting the Opioid Epidemic
Author: Amitava Dasgupta
Publsiher: Elsevier
Total Pages: 160
Release: 2020-07-22
Genre: Medical
ISBN: 9780128223901

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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

Pain Management for People with Serious Illness in the Context of the Opioid Use Disorder Epidemic

Pain Management for People with Serious Illness in the Context of the Opioid Use Disorder Epidemic
Author: National Academies of Sciences, Engineering, and Medicine,Health and Medicine Division,Board on Health Sciences Policy,Board on Health Care Services,Roundtable on Quality Care for People with Serious Illness
Publsiher: National Academies Press
Total Pages: 104
Release: 2019-08-01
Genre: Medical
ISBN: 9780309492232

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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.

Medications for Opioid Use Disorder Save Lives

Medications for Opioid Use Disorder Save Lives
Author: National Academies of Sciences, Engineering, and Medicine,Health and Medicine Division,Board on Health Sciences Policy,Committee on Medication-Assisted Treatment for Opioid Use Disorder
Publsiher: National Academies Press
Total Pages: 174
Release: 2019-05-16
Genre: Medical
ISBN: 9780309486514

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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.

A Time Release History of the Opioid Epidemic

A Time Release History of the Opioid Epidemic
Author: J.N. Campbell,Steven M. Rooney
Publsiher: Springer
Total Pages: 134
Release: 2018-06-20
Genre: Science
ISBN: 3319917870

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This Brief takes the reader on a chemical journey by following the history for over two centuries of how an opiate became an opioid, thus spawning an empire and a series of crises. These imperfect resemblances of alkaloids are both natural and synthetic substances that, particularly in America, are continually part of a growing concern about overuse. This seemed an inviting prospect for those in pain, but as the ubiquitous media coverage continues to lay bare, the levels of abuse point to the fact that perhaps an epidemic is upon us, if not a culture war. Seeking answers to how and why this addiction crisis transpired over two hundred years of long development, this Brief examines the role that the chemistry laboratory played in turning patients into consumers. By utilizing a host of diverse sources, this Brief seeks to trace the design and the production of opioids and their antecedents over the past two centuries. From the isolation and development of the first alkaloids with morphine that relieved pain within the home and on the battlefield, to the widespread use of nostrums and the addiction crisis that ensued, to the dissemination of drugs by what became known as Big Pharma after the World Wars; and finally, to competition from home-made pharmaceuticals, the progenitor was always, in some form, a type of chemistry lab. At times, the laboratory pressed science to think deeply about society's maladies, such as curing disease and alleviating pain, in order to look for new opportunities in the name of progress. Despite the best intentions opioids have created a paradox of pain as they were manipulated by creating relief with synthetic precision and influencing a dystopian vision. Thus, influence came in many forms, from governments, from the medical community, and from the entrepreneurial aspirations of the general populace. For better, but mostly for worse, all played a role in changing forever the trajectory of what started with the isolation of a compound in Germany. Combining chemistry and history in a rousing new long-form narrative that even broadens the definition of a laboratory, the origins and future of this complicated topic are carefully examined.

Cancer Pain Management

Cancer Pain Management
Author: Deborah B. McGuire,Connie Henke Yarbro,Betty Ferrell
Publsiher: Jones & Bartlett Learning
Total Pages: 404
Release: 1995
Genre: Medical
ISBN: 0867207256

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Cancer Pain Management, Second Edition will substantially advance pain education. The unique combination of authors -- an educator, a leading practitioner and administrator, and a research scientist -- provides comprehensive, authoritative coverage in addressing this important aspect of cancer care. The contributors, acknowledged experts in their areas, address a wide scope of issues. Educating health care providers to better assess and manage pain and improve patientsrsquo; and familiesrsquo; coping strategies are primary goals of this book. Developing research-based clinical guidelines and increasing funding for research is also covered. Ethical issues surrounding pain management and health policy implications are also explored.

The Opioid Epidemic in the United States

The Opioid Epidemic in the United States
Author: Kant B. Patel,Mark E. Rushefsky
Publsiher: Routledge
Total Pages: 376
Release: 2021-09-30
Genre: Political Science
ISBN: 9781000456325

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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.

Textbook of Palliative Medicine

Textbook of Palliative Medicine
Author: Eduardo Bruera,Irene Higginson,Charles F von Gunten
Publsiher: CRC Press
Total Pages: 1024
Release: 2009-01-30
Genre: Health & Fitness
ISBN: 9780340966242

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Textbook of Palliative Medicine provides an alternative, truly international approach to this rapidly growing specialty. This textbook fills a niche with its evidence-based, multi-professional approach and global perspective ensured by the international team of editors and contributing authors. In the absence of an international curriculum for the study of palliative medicine, this textbook provides essential guidance for those both embarking upon a career in palliative medicine or already established in the field, and the structure and content have been constructed very much with this in mind. With an emphasis on providing a service anywhere in the world, including the important issue of palliative care in the developing nations, Textbook of Palliative Medicine offers a genuine alternative to the narrative approach of its competitors, and is an ideal complement to them. It is essential reading for all palliative care physicians in training and in practice, as well as palliative care nurses and other health professionals in the palliative care team

In Pain

In Pain
Author: Travis Rieder
Publsiher: HarperCollins
Total Pages: 320
Release: 2019-06-18
Genre: Social Science
ISBN: 9780062854667

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NPR Best Book of 2019 A bioethicist’s eloquent and riveting memoir of opioid dependence and withdrawal—a harrowing personal reckoning and clarion call for change not only for government but medicine itself, revealing the lack of crucial resources and structures to handle this insidious nationwide epidemic. Travis Rieder’s terrifying journey down the rabbit hole of opioid dependence began with a motorcycle accident in 2015. Enduring half a dozen surgeries, the drugs he received were both miraculous and essential to his recovery. But his most profound suffering came several months later when he went into acute opioid withdrawal while following his physician’s orders. Over the course of four excruciating weeks, Rieder learned what it means to be “dope sick”—the physical and mental agony caused by opioid dependence. Clueless how to manage his opioid taper, Travis’s doctors suggested he go back on the drugs and try again later. Yet returning to pills out of fear of withdrawal is one route to full-blown addiction. Instead, Rieder continued the painful process of weaning himself. Rieder’s experience exposes a dark secret of American pain management: a healthcare system so conflicted about opioids, and so inept at managing them, that the crisis currently facing us is both unsurprising and inevitable. As he recounts his story, Rieder provides a fascinating look at the history of these drugs first invented in the 1800s, changing attitudes about pain management over the following decades, and the implementation of the pain scale at the beginning of the twenty-first century. He explores both the science of addiction and the systemic and cultural barriers we must overcome if we are to address the problem effectively in the contemporary American healthcare system. In Pain is not only a gripping personal account of dependence, but a groundbreaking exploration of the intractable causes of America’s opioid problem and their implications for resolving the crisis. Rieder makes clear that the opioid crisis exists against a backdrop of real, debilitating pain—and that anyone can fall victim to this epidemic.

Pain Killer

Pain Killer
Author: Barry Meier
Publsiher: Random House
Total Pages: 240
Release: 2018-05-29
Genre: Medical
ISBN: 9780525511090

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A Pulitzer Prize–winning New York Times reporter exposes the roots of the opioid epidemic at the hands of Purdue Pharma and Raymond and Mortimer Sackler in Pain Killer, a “timely, compelling, important” (The Seattle Times) story of corporate greed and government negligence. “Groundbreaking . . . Pain Killer is the shocking account of the origins of today’s opioid epidemic, the creators of this plague, and the way to help stop it.”—Sam Quinones, author of Dreamland: The True Tale of America’s Opiate Epidemic Between 1999 and 2017, an estimated 250,000 Americans died from overdoses involving prescription painkillers, a plague ignited by Purdue Pharma’s aggressive marketing of OxyContin. Families, working class and wealthy, have been torn apart, businesses destroyed, and public officials pushed to the brink. Meanwhile, the drugmaker’s owners, Raymond and Mortimer Sackler, whose names adorn museums worldwide, made enormous fortunes from the commercial success of OxyContin. In Pain Killer, Barry Meier tells the story of how Purdue turned OxyContin into a billion-dollar blockbuster. Powerful narcotic painkillers, or opioids, were once used as drugs of last resort for pain sufferers. But Purdue launched an unprecedented marketing campaign claiming that the drug’s long-acting formulation made it safer to use than traditional painkillers for many types of pain. That illusion was quickly shattered as drug abusers learned that crushing an Oxy could release its narcotic payload all at once. Even in its prescribed form, Oxy proved fiercely addictive. As OxyContin’s use and abuse grew, Purdue concealed what it knew from regulators, doctors, and patients. Here are the people who profited from the crisis and those who paid the price, those who plotted in boardrooms and those who tried to sound alarm bells. A country doctor in rural Virginia, Art Van Zee, took on Purdue and warned officials about OxyContin abuse. An ebullient high school cheerleader, Lindsey Myers, was reduced to stealing from her parents to feed her escalating Oxy habit. A hard-charging DEA official, Laura Nagel, tried to hold Purdue executives to account. In this updated edition of Pain Killer, Barry Meier breaks new ground in his decades-long investigation into the opioid epidemic. He takes readers inside Purdue to show how long the company withheld information about the abuse of OxyContin and gives a shocking account of the Justice Department’s failure to alter the trajectory of the opioid epidemic and protect thousands of lives. Equal parts crime thriller, medical detective story, and business exposé, Pain Killer is a hard-hitting look at how a supposed wonder drug became the gateway drug to a national tragedy.

Relieving Pain in America

Relieving Pain in America
Author: Institute of Medicine,Board on Health Sciences Policy,Committee on Advancing Pain Research, Care, and Education
Publsiher: National Academies Press
Total Pages: 382
Release: 2011-10-26
Genre: Medical
ISBN: 9780309214841

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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 American Opioid Epidemic

The American Opioid Epidemic
Author: Michael T. Compton, M.D., M.P.H.,Marc W. Manseau, M.D., M.P.H.
Publsiher: American Psychiatric Pub
Total Pages: 459
Release: 2018-12-31
Genre: Medical
ISBN: 9781615371570

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This book provides an in-depth look at clinical and public health approaches to this epidemic from both psychiatric and medical perspectives and gives mental health professionals the big picture necessary to understand the epidemic.

Drug Dealer MD

Drug Dealer  MD
Author: Anna Lembke
Publsiher: JHU Press
Total Pages: 172
Release: 2016-11-15
Genre: Medical
ISBN: 9781421421407

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Three out of four people addicted to heroin probably started on a prescription opioid, according to the director of the Centers for Disease Control and Prevention. In the United States alone, 16,000 people die each year as a result of prescription opioid overdose. But perhaps the most frightening aspect of the prescription drug epidemic is that it’s built on well-meaning doctors treating patients with real problems. In Drug Dealer, MD, Dr. Anna Lembke uncovers the unseen forces driving opioid addiction nationwide. Combining case studies from her own practice with vital statistics drawn from public policy, cultural anthropology, and neuroscience, she explores the complex relationship between doctors and patients, the science of addiction, and the barriers to successfully addressing drug dependence and addiction. Even when addiction is recognized by doctors and their patients, she argues, many doctors don’t know how to treat it, connections to treatment are lacking, and insurance companies won’t pay for rehab. Full of extensive interviews—with health care providers, pharmacists, social workers, hospital administrators, insurance company executives, journalists, economists, advocates, and patients and their families—Drug Dealer, MD, is for anyone whose life has been touched in some way by addiction to prescription drugs. Dr. Lembke gives voice to the millions of Americans struggling with prescription drugs while singling out the real culprits behind the rise in opioid addiction: cultural narratives that promote pills as quick fixes, pharmaceutical corporations in cahoots with organized medicine, and a new medical bureaucracy focused on the bottom line that favors pills, procedures, and patient satisfaction over wellness. Dr. Lembke concludes that the prescription drug epidemic is a symptom of a faltering health care system, the solution for which lies in rethinking how health care is delivered.

Empire of Pain

Empire of Pain
Author: Patrick Radden Keefe
Publsiher: Bond Street Books
Total Pages: 480
Release: 2021-04-13
Genre: Business & Economics
ISBN: 9780385697552

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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, by the prize-winning, bestselling author of Say Nothing The Sackler name adorns 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, known for their lavish donations to the arts and the sciences. The source of the family fortune was vague, however, 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 begins with the story of three doctor brothers, Raymond, Mortimer and the incalculably energetic Arthur, who weathered the poverty of the Great Depression and appalling anti-Semitism. Working at a barbaric mental institution, Arthur saw a better way and conducted groundbreaking research into drug treatments. He also had a genius for marketing, especially for pharmaceuticals, and bought a small ad firm. Arthur devised the marketing for Valium, and built the first great Sackler fortune. He purchased a drug manufacturer, Purdue Frederick, which would be run by Raymond and Mortimer. The brothers began collecting art, and wives, and grand residences in exotic locales. Their children and grandchildren grew up in luxury. Forty years later, Raymond’s son Richard ran the family-owned Purdue. The template Arthur Sackler created to sell Valium—co-opting doctors, influencing the FDA, downplaying the drug’s addictiveness—was employed to launch a far more potent product: OxyContin. The drug went on to generate some thirty-five billion dollars in revenue, and to launch a public health crisis in which hundreds of thousands would die. This 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. 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. 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. Empire of Pain is a masterpiece of narrative reporting and writing, exhaustively documented and ferociously compelling. It is a portrait of the excesses of America’s second Gilded Age, a study of impunity among the super elite and a relentless investigation of the naked greed and indifference to human suffering that built one of the world’s great fortunes.

Advanced Cancer

Advanced Cancer
Author: Edward Chow,Joav Merrick
Publsiher: Nova Biomedical Books
Total Pages: 320
Release: 2010
Genre: Medical
ISBN: 1616682078

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An estimated 166,400 new cases of cancer will occur in Canada in 2008. Bone metastases unfortunately remain a common site of recurrence, with breast and prostate cancer patients representing a substantial proportion of this population. Metastatic bone disease is associated with significant morbidity and mortality. Pain is experienced by up to two thirds of patients. The prognosis for patients with bone metastases is highly influenced by tumour type, performance status, and the presence of extraosseous disease. The median survival has been significantly longer in breast cancer patients with a first relapse in the axial skeleton (24 months) versus patients with initial relapse in the liver (3 months) (2). Survival after diagnosis of bone metastases is influenced by the subsequent development of extraosseous metastatic sites: 1.6 years versus 2.1 years in patients with bone-only disease.