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Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use PAIN MANAGEMENT AND THE OPIOID EPIDEMIC BALANCING SOCIETAL AND INDIVIDUAL BENEFITS AND RISKS OF PRESCRIPTION OPIOID USE Committee on Pain Management and Regulatory Strategies to Address Prescription Opioid Abuse Richard J. Bonnie, Morgan A. Ford, and Jonathan K. Phillips, Editors Board on Health Sciences Policy Health and Medicine Division A Consensus Study Report of PREPUBLICATION COPY: UNCORRECTED PROOFS Copyright © National Academy of Sciences. All rights reserved. Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001 This activity was supported by Grant No. HHSF223201610015C from the U.S. Food and Drug Administration. 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/10.17226/24781 Library of Congress Control Number 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 2017 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. 2017. Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/24781. PREPUBLICATION COPY: UNCORRECTED PROOFS Copyright © National Academy of Sciences. All rights reserved. Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use 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 Copyright © National Academy of Sciences. All rights reserved. Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use 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 Copyright © National Academy of Sciences. All rights reserved. Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use COMMITTEE ON PAIN MANAGEMENT AND REGULATORY STRATEGIES TO ADDRESS PRESCRIPTION OPIOID ABUSE RICHARD J. BONNIE (Chair), Harrison Foundation Professor of Medicine and Law; Director, Institute of Law, Psychiatry and Public Policy, University of Virginia School of Law, Charlottesville HORTENSIA AMARO, Associate Vice Provost for Community Research Initiatives; Dean’s Professor of Social Work and Preventive Medicine, School of Social Work, University of Southern California, Los Angeles LINDA BURNES BOLTON, System Chief Nurse Executive; Vice President, Nursing; Chief Nursing Officer, Cedars Sinai Medical Center, Los Angeles, California JONATHAN P. CAULKINS, H. Guyford Stever Professor of Operations Research and Public Policy, Heinz School of Public Policy and Management, Carnegie Mellon University, Pittsburgh, Pennsylvania DAVID CLARK, Professor of Anesthesia, Perioperative Pain Medicine and Pain, Stanford University; Director, Veterans Affairs Pain Clinic, Palo Alto, California ELI ELIAV, Professor and Director, Eastman Institute for Oral Health; Vice Dean for Oral Health, School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, New York GARRET FITZGERALD, McNeil Professor in Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia TRACI C. GREEN, Deputy Director, Injury Prevention Center, Boston Medical Center, Boston University School of Medicine, Massachusetts; Associate Professor of Emergency Medicine and Epidemiology, The Warren Alpert School of Medicine, Brown University, Providence, Rhode Island MIGUEL HERNÁN, Kolokotrones Professor of Biostatistics and Epidemiology, Harvard T. H. Chan School of Public Health; Harvard-Massachusetts Institute of Technology Division of Health Sciences and Technology, Boston, Massachusetts LEE D. HOFFER, Associate Professor, Department of Anthropology, Case Western Reserve University, Cleveland, Ohio PAUL E. JARRIS, Senior Vice President of Maternal and Child Health Program Impact; Deputy Medical Director, March of Dimes Foundation, Washington, DC KAROL KALTENBACH, Emeritus Professor of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania AARON S. KESSELHEIM, Associate Professor of Medicine, Harvard Medical School, Boston, Massachusetts ANNE MARIE McKENZIE-BROWN, Associate Professor of Anesthesiology; Director, Division of Pain Management, Emory University School of Medicine, Atlanta, Georgia JOSE MORON-CONCEPCION, Associate Professor of Anesthesiology, School of Medicine, Washington University, St. Louis, Missouri A. DAVID PALTIEL, Professor, Department of Health Policy and Management, School of Public Health, School of Management, Yale University, New Haven, Connecticut VALERIE REYNA, Professor of Human Development; Director of the Human Neuroscience Institute, Cornell University, Ithaca, New York MARK SCHUMACHER, Chief, Division of Pain Medicine; Professor of Anesthesiology, School of Medicine, University of California, San Francisco Study Staff MORGAN A. FORD, Study Director JONATHAN K. PHILLIPS, Associate Program Officer ANNE CLAIBORNE, Senior Program Officer CLARE STROUD, Senior Program Officer (until May 2017) v PREPUBLICATION COPY: UNCORRECTED PROOFS Copyright © National Academy of Sciences. All rights reserved. Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use PAMELA REESE, Senior Program Assistant (until July 2016) THELMA L. COX, Senior Program Assistant (August 2016 through December 2016) DANIEL FLYNN, Senior Program Assistant (starting December 2016) HILARY BRAGG, Program Coordinator, Board on Health Sciences Policy CHRISTIE BELL, Financial Officer ANDREW M. POPE, Director, Board on Health Sciences Policy Consultants RONA BRIERE, Consultant Editor ERIN HAMMERS FORSTAG, Freelance Science Writer MARGARET FOSTER RILEY, University of Virginia PATRICIA J. ZETTLER, Georgia State University vi PREPUBLICATION COPY: UNCORRECTED PROOFS Copyright © National Academy of Sciences. All rights reserved. Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use REVIEWERS This Consensus Study Report 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
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