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.

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.

Opioid research is one of the multidisciplinary research areas that involve advanced techniques ranging from molecular genetics to neuropharmacology, and from behavioral neuroscience to clinical medicine. In current opioid research, it has become increasingly important to use multiple approaches at molecular, cellular, and system levels for investigations on a specific opio- related target system. That often requires understanding and applying cro- field techniques and methods for the success of one’s research projects. Through its broad spectrum of coverage, Opioid Research: Methods and Protocols provides a comprehensive collection of major laboratory methods and protocols in current opioid research, covering topics from molecular and genetic techniques to behavioral analyses of animal models, and then to clinical practice. It will serve as a convenient reference book from which those involved in opioid research will learn or perfect the necessary cross-field techniques. The detailed methods and protocols described in Opioid Research: Methods and Protocols have each been successfully applied in current opioid research. Part I provides molecular techniques for the cloning and expression of opioid receptors, and for the quantitative characterization of their signaling pathways. Part II includes primary techniques for mapping the distributions and detecting the expression levels of opioid receptors, opioid peptides, and their messages in brain tissues and in individual cells. Part III deals with methods for creating in vitro receptor models and in vivo animal models to study opioid functions. Part IV describes practical applications of opioids in clinical medicine for the treatment of pain and opioid addiction.

Recent Advances in the Synthesis of Morphine and Related Alkaloids; by N. Chida * Opioids in Preclinical and Clinical Trials; by H. Nagase and H. Fujii * Synthesis of 14-Alkoxymorphinan Derivatives and Their Pharmacological Actions; by H. Schmidhammer and M. Spetea * 14-Amino-4,5-Epoxymorphinan Derivatives and Their Pharmacological Actions; by J. W. Lewis and S. M. Husbands * Nonpeptidic Delta (δ) Opioid Agonists and Antagonists of the Diarylmethylpiperazine Class: What Have We Learned?; by S. N. Calderon * Synthesis of Neoclerodane Diterpenes and Their Pharmacological Effects; by K. M. Lovell, K. M. Prevatt-Smith, A. Lozama and T. E. Prisinzano * Synthesis of Novel Basic Skeletons Derived from Naltrexone; by H. Nagase and H. Fujii * Twin and Triplet Drugs in Opioid Research; by H. Fujii * 3D-Pharmacophore Identification for κ-Opioid Agonists Using Ligand-Based Drug-Design Techniques; by N. Yamaotsu and S. Hirono

A comprehensive portrait of a uniquely American epidemic -- devastating in its findings and damning in its conclusions The opioid epidemic has been described as "one of the greatest mistakes of modern medicine." But calling it a mistake is a generous rewriting of the history of greed, corruption, and indifference that pushed the US into consuming more than 80 percent of the world's opioid painkillers. Journeying through lives and communities wrecked by the epidemic, Chris McGreal reveals not only how Big Pharma hooked Americans on powerfully addictive drugs, but the corrupting of medicine and public institutions that let the opioid makers get away with it. The starting point for McGreal's deeply reported investigation is the miners promised that opioid painkillers would restore their wrecked bodies, but who became targets of "drug dealers in white coats." A few heroic physicians warned of impending disaster. But American Overdose exposes the powerful forces they were up against, including the pharmaceutical industry's coopting of the Food and Drug Administration and Congress in the drive to push painkillers -- resulting in the resurgence of heroin cartels in the American heartland. McGreal tells the story, in terms both broad and intimate, of people hit by a catastrophe they never saw coming. Years in the making, its ruinous consequences will stretch years into the future.