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.

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.

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 interest in opioids such as morphine, the prototypical opioid ligand, has been maintained through the years. The identification of endogenous opioids and their receptors (mu, delta, kappa, and nociceptin), molecular cloning, and the elucidation of the crystal structures of opioid receptors represent key milestones in opioid research. The opioid system modulates numerous pharmacological responses, with therapeutic (i.e., analgesia) and detrimental side effects (i.e., addiction). The medical use and misuse of opioids have dramatically increased, leading to the 21st century opioid crisis. This book presents recent developments in opioid drug discovery, specifically in the medicinal chemistry and pharmacology of new ligands targeting the opioid receptors as effective and safe therapeutics for human diseases. Furthermore, it draws a special attention to advancing concepts and strategies in opioid drug discovery to mitigate opioid liabilities. The diversity among the discussed topics is a testimony to the complexity of the opioid system, which results from the expression, regulation, and functional role of ligands and receptors. The array of multidisciplinary research areas illustrates the rapidly developing basic research and translational activities in opioid drug discovery. This book will serve as a useful reference while also stimulating continued research in the chemistry and pharmacology of opioids and their receptors, with the prospect of developing improved therapies for human diseases, but also improving health and quality of life in general.

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.

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