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.

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.

In this issue of Anesthesiology Clinics, guest editors Drs. Zdravka Zafirova and Richard D. Urman bring their considerable expertise to the topic of Preoperative Patient Evaluation. Top experts in the field discuss this important opportunity to identify co-morbidities that may lead to patient complications during the anaesthetic, surgical, or post-operative period, including anticoagulation preop management and regional anesthesia recent updates/guidelines; marijuana use and vaping; enhanced recovery pathways: preoperative considerations in children; management of preoperative anemia; and more. - Contains 17 relevant, practice-oriented topics including what's new in preop cardiac testing; virtual preoperative evaluation process: a new paradigm; newer hypoglycemic medications; new therapies for heart failure and pulmonary hypertension; preoperative management of the adult patient with cancer; and more. - Provides in-depth clinical reviews on preoperative patient evaluation, offering actionable insights for clinical practice. - Presents the latest information on this timely, focused topic under the leadership of experienced editors in the field. Authors synthesize and distill the latest research and practice guidelines to create clinically significant, topic-based reviews.

Thoroughly revised to reflect contemporary diagnostics and treatment, this Third Edition is a comprehensive and practical reference on the assessment and management of acute and chronic pain. This edition features 14 new chapters and is filled with new information on invasive procedures...pharmacologic interventions...neuraxial pharmacotherapy...physical and occupational therapies...diagnostic techniques...pain in terminally ill patients...cancer pain...visceral pain...rheumatologic disorders...managed care...and medicolegal issues. Reorganized with two new sections focusing on diagnostics and cancer pain. A Brandon-Hill recommended title.

Basic knowledge about the nature and treatment of stimulant use disorders. Reviews what is currently known about treating the med., psychiatric, and substance abuse-dependence problems assoc. with the use of 2 high-profile stimulants: cocaine and methamphetamine (MA). The info. is understandable and relevant for clinicians and other "front line" substance use disorder treat. providers. Offers recomm. on treat. approaches, recomm. to maximize treat. engagement, strategies for planning and initiating treat., and strategies for initiating and maintaining abstinence. Includes recomm. for the med. mgmt. of stimulant users and recomm. regarding special groups and settings.

An estimated 69000 people die each year from opioid overdose. Opioid overdose is easily reversed with the opioid antidote naloxone and with basic life support. Such care is generally only available in medical settings, however. These guidelines recommend that people who are likely to witness an opioid overdose, including people who use opioids, and their family and friends should be given access to naloxone and training in its use so that they can respond to opioid overdose in an emergency if a medical response is not available. Naloxone can be injected or administered intra-nasally and has minimal effects in people who have not used opioids. While naloxone administered by bystanders is a potentially life-saving emergency interim response to opioid overdose, it should not be seen as a replacement for comprehensive medical care.

Deaths involving synthetic opioids, such as fentanyl, increased from roughly 3,000 in 2013 to more than 30,000 in 2018. This book provides readers with insights intended to improve their understanding of the synthetic opioid problem.