National Academies Press: OpenBook
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Pain Management for People with Serious Illness in the Context of the Opioid Use Disorder Epidemic: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25435.
×
Page R1
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Pain Management for People with Serious Illness in the Context of the Opioid Use Disorder Epidemic: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25435.
×
Page R2
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Pain Management for People with Serious Illness in the Context of the Opioid Use Disorder Epidemic: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25435.
×
Page R3
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Pain Management for People with Serious Illness in the Context of the Opioid Use Disorder Epidemic: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25435.
×
Page R4
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Pain Management for People with Serious Illness in the Context of the Opioid Use Disorder Epidemic: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25435.
×
Page R5
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Pain Management for People with Serious Illness in the Context of the Opioid Use Disorder Epidemic: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25435.
×
Page R6
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Pain Management for People with Serious Illness in the Context of the Opioid Use Disorder Epidemic: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25435.
×
Page R7
Page viii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Pain Management for People with Serious Illness in the Context of the Opioid Use Disorder Epidemic: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25435.
×
Page R8
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Pain Management for People with Serious Illness in the Context of the Opioid Use Disorder Epidemic: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25435.
×
Page R9
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Pain Management for People with Serious Illness in the Context of the Opioid Use Disorder Epidemic: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25435.
×
Page R10
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Pain Management for People with Serious Illness in the Context of the Opioid Use Disorder Epidemic: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25435.
×
Page R11
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Pain Management for People with Serious Illness in the Context of the Opioid Use Disorder Epidemic: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25435.
×
Page R12
Page xiii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Pain Management for People with Serious Illness in the Context of the Opioid Use Disorder Epidemic: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25435.
×
Page R13
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Pain Management for People with Serious Illness in the Context of the Opioid Use Disorder Epidemic: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25435.
×
Page R14
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Pain Management for People with Serious Illness in the Context of the Opioid Use Disorder Epidemic: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25435.
×
Page R15
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Pain Management for People with Serious Illness in the Context of the Opioid Use Disorder Epidemic: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25435.
×
Page R16
Page xvii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Pain Management for People with Serious Illness in the Context of the Opioid Use Disorder Epidemic: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25435.
×
Page R17
Page xviii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Pain Management for People with Serious Illness in the Context of the Opioid Use Disorder Epidemic: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25435.
×
Page R18

Below is the uncorrected machine-read text of this chapter, intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text of each book. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

Pain Management for People with Serious Illness in the Context of the Opioid Use Disorder Epidemic PROCEEDINGS OF A WORKSHOP Laurene Graig, India Olchefske, and Joe Alper, Rapporteurs Roundtable on Quality Care for People with Serious Illness Board on Health Care Services Board on Health Sciences Policy Health and Medicine Division

THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001 This activity was supported by Aetna Inc., Altarum Institute, American Academy of Hospice and Palliative Medicine, American Cancer Society, American Geriatrics Society, Anthem Inc., Ascension Health, Association of Professional Chaplains, Association of Rehabilitation Nurses, Blue Cross Blue Shield Association, Blue Cross Blue Shield of Massachusetts, Blue Cross and Blue Shield of North Carolina, Bristol-Myers Squibb, The California State University Institute for Palliative Care, Cambia Health Solutions, Cedars-Sinai Health System, Center to Advance Palliative Care, Centers for Medicare & Medicaid Services, Coalition to Transform Advanced Care, Excellus BlueCross BlueShield, Federation of American Hospitals, The Greenwall Foundation, The John A. Hartford Foundation, Hospice and Palliative Nurses Association, Kaiser Permanente, Susan G. Komen, Gordon and Betty Moore Foundation, National Coalition for Hospice and Palliative Care, National Hospice and Palliative Care Organization, National Palliative Care Research Center, National Patient Advocate Foundation, National Quality Forum, The New York Academy of Medicine, Oncology Nursing Society, Patient-Centered Outcomes Research Institute, Social Work Hospice and Palliative Care Network, Supportive Care Coalition, and UnitedHealth Group, and the National Academy of Medicine. The MAYDAY Fund also provided support for this project. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project. International Standard Book Number–13: 978-0-309-xxxxx-x International Standard Book Number–10: 0-309-xxxxx-x Digital Object Identifier: https://doi.org/10.17226/25435 Additional copies of this publication are available for sale from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. Copyright 2019 by the National Academy of Sciences. All rights reserved. Printed in the United States of America Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2019. Pain management for people with serious illness in the context of the opioid use disorder epidemic: proceedings of a workshop. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/25435 PREPUBLICATION COPY: UNCORRECTED PROOFS

The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president. The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. C. D. Mote, Jr., is president. The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president. The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine. Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org. PREPUBLICATION COPY: UNCORRECTED PROOFS

Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the study’s statement of task by an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process and it represents the position of the National Academies on the statement of task. Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at a workshop, symposium, or other event convened by the National Academies. The statements and opinions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies. For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/whatwedo. PREPUBLICATION COPY: UNCORRECTED PROOFS

PLANNING COMMITTEE FOR A WORKSHOP ON PAIN MANAGEMENT FOR PEOPLE WITH SERIOUS ILLNESS IN THE CONTEXT OF THE OPIOID USE DISORDER EPIDEMIC 1 ANDREW DREYFUS (Co-Chair), President and Chief Executive Officer, Blue Cross Blue Shield of Massachusetts JAMES A. TULSKY (Co-Chair), Chair, Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute; Chief, Division of Palliative Medicine, Department of Medicine, Brigham and Women’s Hospital; Professor of Medicine and Co-Director, Center for Palliative Care, Harvard Medical School PATRICIA A. BOMBA, Vice President and Medical Director, Geriatrics, Excellus BlueCross BlueShield STEVE CLAUSER, Program Director, Improving Healthcare Systems, Patient-Centered Outcomes Research Institute REBECCA KIRCH, Executive Vice President of Healthcare Quality and Value, National Patient Advocate Foundation JANE LIEBSCHUTZ, Chief, Division of General Internal Medicine, University of Pittsburgh Medical Center Health System, University of Pittsburgh School of Medicine SALIMAH MEGHANI, Associate Professor of Nursing and Term Chair in Palliative Care, Department of Biobehavioral Health Sciences; Associate Director, New Courtland Center for Transitions and Health; Senior Fellow, Leonard Davis Institute of Health Economics, University of Pennsylvania R. SEAN MORRISON, Director, National Palliative Care Research Center JUDITH PAICE, Director, Cancer Pain Program, Division of Hematology-Oncology, and Research Professor of Medicine, Feinberg School of Medicine, Northwestern University PHILIP PIZZO, Founding Director, Stanford Distinguished Careers Institute; Former Dean and David and Susan Heckerman Professor of Pediatrics and of Microbiology and Immunology, Stanford University School of Medicine CHRISTIAN SINCLAIR, Associate Professor, Division of Palliative Medicine, University of Kansas Health System, representing the American Academy of Hospice and Palliative Medicine Project Staff LAURENE GRAIG, Director, Roundtable on Quality Care for People with Serious Illness SYLARA MARIE CRUZ, Research Associate RAJBIR KAUR, Senior Program Assistant, Roundtable on Quality Care for People with Serious Illness SHARYL NASS, Director, Board on Health Care Services, and Director, National Cancer Policy Forum INDIA OLCHEFSKE, Research Associate ANDREW M. POPE, Director, Board on Health Sciences Policy 1 The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution. v PREPUBLICATION COPY: UNCORRECTED PROOFS

Consultant JOE ALPER, Consulting Writer vi PREPUBLICATION COPY: UNCORRECTED PROOFS

ROUNDTABLE ON QUALITY CARE FOR PEOPLE WITH SERIOUS ILLNESS1 LEONARD D. SCHAEFFER (Chair), Judge Robert Maclay Widney Chair and Professor, University of Southern California JAMES A. TULSKY (Vice Chair), Chair, Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute; Chief, Division of Palliative Medicine, Brigham and Women’s Hospital; Professor of Medicine and Co-Director, Center for Palliative Care, Harvard Medical School JENNIFER BALLENTINE, Executive Director, The California State University Institute for Palliative Care ROBERT A. BERGAMINI, Medical Director, Palliative Care Services, Mercy Clinic Children’s Cancer and Hematology, representing the Supportive Care Coalition AMY J. BERMAN, Senior Program Officer, The John A. Hartford Foundation LORI BISHOP, Vice President of Palliative and Advanced Care, National Hospice and Palliative Care Organization PATRICIA A. BOMBA, Vice President and Medical Director, Geriatrics, Excellus BlueCross BlueShield SUSAN BROWN, Senior Director, Health Education, Susan G. Komen GRACE B. CAMPBELL, Assistant Professor, Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, representing the Association of Rehabilitation Nurses STEVE CLAUSER, Program Director, Improving Healthcare Systems Research Program, Patient-Centered Outcomes Research Institute PATRICK CONWAY, President and Chief Executive Officer-Elect, Blue Cross and Blue Shield of North Carolina DAVID J. DEBONO, Medical Director, Oncology, Anthem, Inc. CHRISTOPHER M. DEZII, Lead, Quality and Measure Development, State and Federal Payment Agencies, U.S. Value, Access and Payment, Bristol-Myers Squibb ANDREW DREYFUS, President and Chief Executive Officer, Blue Cross Blue Shield of Massachusetts CAROLE REDDING FLAMM, Executive Medical Director, Blue Cross Blue Shield Association MARK B. GANZ, President and Chief Executive Officer, Cambia Health Solutions ZIAD R. HAYDAR, Senior Vice President and Chief Clinical Officer, Ascension Health PAMELA S. HINDS, Director of Nursing Research and Quality Outcomes, Children’s National Health System HAIDEN HUSKAMP, 30th Anniversary Professor of Health Care Policy, Harvard Medical School KIMBERLY JOHNSON, Associate Professor of Medicine, Senior Fellow in the Center for the Study of Aging and Human Development, Duke University School of Medicine CHARLES N. KAHN III, President and Chief Executive Officer, Federation of American Hospitals REBECCA A. KIRCH, Executive Vice President of Healthcare Quality and Value, National Patient Advocate Foundation TOM KOUTSOUMPAS, Co-Founder, Coalition to Transform Advanced Care SHARI M. LING, Deputy Chief Medical Officer, Centers for Medicare & Medicaid Services vii PREPUBLICATION COPY: UNCORRECTED PROOFS

BERNARD LO, President and Chief Executive Officer, The Greenwall Foundation JOANNE LYNN, Director, Center for Elder Care and Advanced Illness, Altarum Institute DIANE E. MEIER, Director, Center to Advance Palliative Care AMY MELNICK, Executive Director, National Coalition for Hospice and Palliative Care JERI L. MILLER, Chief, Office of End-of-Life and Palliative Care Research, National Institute of Nursing Research, National Institutes of Health R. SEAN MORRISON, Director, National Palliative Care Research Center BRENDA NEVIDJON, Chief Executive Officer, Oncology Nursing Society HAROLD L. PAZ, Executive Vice President and Chief Medical Officer, Aetna Inc. JUDITH R. PERES, Long-Term and Palliative Care Consultant, Clinical Social Worker and Board Member, Social Work Hospice and Palliative Care Network PHILLIP A. PIZZO, Founding Director, Stanford Distinguished Careers Institute, Former Dean, Stanford School of Medicine and David and Susan Heckerman Professor of Pediatrics and of Microbiology and Immunology THOMAS M. PRISELAC, President and Chief Executive Officer, Cedars-Sinai Health System JOANNE REIFSNYDER, Executive Vice President, Clinical Operations and Chief Nursing Officer, Genesis Healthcare, representing the Hospice and Palliative Nurses Association RACHEL ROILAND, Director, Serious Illness Care Initiative, National Quality Forum JUDITH A. SALERNO, President, The New York Academy of Medicine DIANE SCHWEITZER, Acting Chief Program Officer, Patient Care Program, Gordon and Betty Moore Foundation KATRINA M. SCOTT, Oncology Chaplain, Massachusetts General Hospital, representing the Association of Professional Chaplains KATHERINE SHARPE, Senior Vice President, Patient and Caregiver Support, American Cancer Society JOSEPH W. SHEGA, Regional Medical Director, VITAS Hospice Care, representing the American Geriatrics Society CHRISTIAN SINCLAIR, Associate Professor, Division of Palliative Medicine, University of Kansas Medical Center, representing the American Academy of Hospice and Palliative Medicine TANYA STEWART, Senior Medical Director, United Healthcare Retiree Solutions SUSAN ELIZABETH WANG, Regional Lead for Shared Decision-Making and Advance Care Planning, Southern California Permanente Medical Group, Kaiser Permanente Roundtable on Quality Care for People with Serious Illness Staff LAURENE GRAIG, Director, Roundtable on Quality Care for People with Serious Illness SYLARA MARIE CRUZ, Research Associate RAJBIR KAUR, Senior Program Assistant, Roundtable on Quality Care for People with Serious Illness INDIA OLCHEFSKE, Research Associate MICAH WINOGRAD, Financial Officer SHARYL NASS, Director, Board on Health Care Services, and Director, National Cancer Policy Forum ANDREW M. POPE, Director, Board on Health Sciences Policy viii PREPUBLICATION COPY: UNCORRECTED PROOFS

Reviewers This Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We thank the following individuals for their review of this proceedings: HAILEY W. BULLS, Moffitt Cancer Center JESSICA MERLIN, University of Pittsburgh BOB TWILLMAN, University of Kansas School of Medicine Although the reviewers listed above provided many const ructive comments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by SARA ROSENBAUM, The George Washington University. She was responsible for making certain that an independent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteurs and the National Academies. ix PREPUBLICATION COPY: UNCORRECTED PROOFS

Acknowledgments The National Academies of Sciences, Engineering, and Medicine’s Roundtable on Quality Care for People with Serious Illness wishes to express its sincere gratitude to the Planning Committee Co-Chairs, Andrew Dreyfus and James Tulsky, for their valuable contributions to the development and orchestration of this workshop. The roundtable also wishes to thank all ofthe members of the planning committee, who collaborated to ensure a workshop complete with informative presentations and rich discussions. Finally, the roundtable thanks the speakers and moderators, who generously shared their expertise and their time with workshop participants. Support from the many annual sponsors of the Roundtable on Quality Care is critical to the roundtable’s work. The sponsors include Aetna Inc., Altarum Institute, American Academy of Hospice and Palliative Medicine, American Cancer Society, American Geriatrics Society, Anthem Inc., Ascension Health, Association of Professional Chaplains, Association of Rehabilitation Nurses, Blue Cross and Blue Shield Association, Blue Cross Blue Shield of Massachusetts, Blue Cross Blue Shield of North Carolina, Bristol-Myers Squibb, The California State University Institute for Palliative Care, Cambia Health Solutions, Cedars-Sinai Health System, Center to Advance Palliative Care, Centers for Medicare & Medicaid Services, Coalition to Transform Advanced Care, Excellus BlueCross BlueShield, Federation of American Hospitals, The Greenwall Foundation, The John A. Hartford Foundation, Hospice and Palliative Nurses Association, Kaiser Permanente, Susan G. Komen, Gordon and Betty Moore Foundation, National Coalition for Hospice and Palliative Care, National Hospice and Palliative Care Organization, National Palliative Care Research Center, National Patient Advocate Foundation, National Quality Forum, The New York Academy of Medicine, Oncology Nursing Society, Patient-Centered Outcomes Research Institute, Social Work Hospice and Palliative Care Network, Supportive Care Coalition, and UnitedHealth Group, and the National Academy of Medicine. The roundtable is grateful to the MAYDAY Fund for its generous support for this workshop. xi PREPUBLICATION COPY: UNCORRECTED PROOFS

Contents ACRONYMS AND ABBREVIATIONS xx INTRODUCTION 1 UNDERSTANDING THE OPIOID USE DISORDER EPIDEMIC AND ITS IMPACT ON PATIENTS, FAMILIES, AND COMMUNITIES 5 PAIN MANAGEMENT FOR PEOPLE WITH SERIOUS ILLNESS: CHALLENGES AND OPPORTUNITIES IN THE CONTEXT OF THE OPIOID USE DISORDER EPIDEMIC 12 A Patient’s Perspective on Opioid Use in Serious Illness, 13 Opioid Correction Versus Opioid Trauma: Where Policy Meets Chronic Pain, 14 Disparities in Access to Pain Medications, 18 Pain Management for Children with Serious Illness: Challenges and Opportunities in the Context of the Opioid Use Disorder Epidemic, 22 Discussion, 24 ADDRESSING THE CHALLENGE OF PATIENTS WITH COMORBID SUBSTANCE USE DISORDER AND SERIOUS ILLNESS 26 Discussion, 30 IMPACT OF POLICY AND REGULATORY RESPONSE TO THE OPIOID USE DISORDER EPIDEMIC ON THE CARE OF PEOPLE WITH SERIOUS ILLNESS 32 State Policies Addressing the Opioid Use Disorder Epidemic, 33 A Federal Perspective on Policies and Regulatory Approaches, 35 A Payer’s Perspective on Policies to Address the Opioid Use Disorder Epidemic, 37 Discussion, 38 CARING FOR PEOPLE WITH SERIOUS ILLNESS IN THE CONTEXT OF THE OPIOID USE DISORDER EPIDEMIC: LESSONS TO INFORM POLICY AND PRACTICE 40 Discussion, 44 REFERENCES 49 APPENDIX A: Statement of Task 56 APPENDIX B: Workshop Agenda 58 xiii PREPUBLICATION COPY: UNCORRECTED PROOFS

Boxes, Figures, and Table BOXES 1 Suggestions Made by Individual Workshop Participants to Improve Pain Management for People with Serious Illness in the Context of the Opioid Use Disorder Epidemic, 3 2 Summary of Key Themes Raised at the Workshop, 40 FIGURES 1 Increase in opioid prescribing, 7 2 Rates of opioid pain reliever (OPR) overdose deaths, OPR treatment admissions, and kilograms of OPR sold, 1999 - 2010, 7 3 Age-adjusted rates of death related to prescription opioids and heroin drug poisoning in the United States, 2000 - 2014, 9 4 Drugs involved in U.S. overdose deaths, 1999-2017, 10 5 U.S. mortality rates have risen because of the opioid use disorder epidemic, 11 6 Equality versus equity, 19 7 Perceptions of disparities in health care, 21 8 An algorithm for deciding what actions to take with patients with serious illness who display behaviors suggestive of a substance use disorder, 29 9 Drug poisoning mortality: United States, 2016, 33 TABLE 1 Definitions of Health Care Disparities, 19 xv PREPUBLICATION COPY: UNCORRECTED PROOFS

Acronyms and Abbreviations AMA American Medical Association CBD cannabidiol CDC Centers for Disease Control and Prevention CMS Centers for Medicare & Medicaid Services DEA Drug Enforcement Administration DSM-V Diagnostic and Statistical Manual of Mental Disorders, 5th Edition FDA Food and Drug Administration HHS U.S. Department of Health and Human Services IOM Institute of Medicine NGA National Governors Association NIH National Institutes of Health NOWs neonatal withdrawal syndrome OPR opioid pain reliever PDMP prescription drug monitoring program SAMHSA Substance Abuse and Mental Health Services Administration STORM Stratification Tool for Opioid Risk Management VA U.S. Department of Veterans Affairs xviii PREPUBLICATION COPY: UNCORRECTED PROOFS

Next: Proceedings of a Workshop »
Pain Management for People with Serious Illness in the Context of the Opioid Use Disorder Epidemic: Proceedings of a Workshop Get This Book
×
Buy Paperback | $50.00
MyNAP members save 10% online.
Login or Register to save!
Download Free PDF

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.

  1. ×

    Welcome to OpenBook!

    You're looking at OpenBook, NAP.edu's online reading room since 1999. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website.

    Do you want to take a quick tour of the OpenBook's features?

    No Thanks Take a Tour »
  2. ×

    Show this book's table of contents, where you can jump to any chapter by name.

    « Back Next »
  3. ×

    ...or use these buttons to go back to the previous chapter or skip to the next one.

    « Back Next »
  4. ×

    Jump up to the previous page or down to the next one. Also, you can type in a page number and press Enter to go directly to that page in the book.

    « Back Next »
  5. ×

    To search the entire text of this book, type in your search term here and press Enter.

    « Back Next »
  6. ×

    Share a link to this book page on your preferred social network or via email.

    « Back Next »
  7. ×

    View our suggested citation for this chapter.

    « Back Next »
  8. ×

    Ready to take your reading offline? Click here to buy this book in print or download it as a free PDF, if available.

    « Back Next »
Stay Connected!