Pain Management and the Opioid Epidemic


Book Description

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.




ARCOS


Book Description




Factorial Survey Experiments


Book Description

Filling a gap in the literature of the field, Factorial Survey Experiments provides researchers with a practical guide to using the factorial survey method to assess respondents’ beliefs about the world, judgment principles, or decision rules through multi-dimensional stimuli (“vignettes”) that resemble real-life decision-making situations. Using insightful examples to illustrate their arguments, authors Katrin Auspurg and Thomas Hinz guide researchers through all relevant steps, including how to set up the factorial experimental design (drawing samples of vignettes and respondents), how to handle the practical challenges that must be mastered when an experimental plan with many different treatments is embedded in a survey format, and how to deal with questions of data analysis. In addition to providing the “how-tos” of designing factorial survey experiments, the authors cover recent developments of similar methods, such as conjoint analyses, choice experiments, and more advanced statistical tools.




Medications for Opioid Use Disorder Save Lives


Book Description

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.




Framing Opioid Prescribing Guidelines for Acute Pain


Book Description

The opioid overdose epidemic combined with the need to reduce the burden of acute pain poses a public health challenge. To address how evidence-based clinical practice guidelines for prescribing opioids for acute pain might help meet this challenge, Framing Opioid Prescribing Guidelines for Acute Pain: Developing the Evidence develops a framework to evaluate existing clinical practice guidelines for prescribing opioids for acute pain indications, recommends indications for which new evidence-based guidelines should be developed, and recommends a future research agenda to inform and enable specialty organizations to develop and disseminate evidence-based clinical practice guidelines for prescribing opioids to treat acute pain indications. The recommendations of this study will assist professional societies, health care organizations, and local, state, and national agencies to develop clinical practice guidelines for opioid prescribing for acute pain. Such a framework could inform the development of opioid prescribing guidelines and ensure systematic and standardized methods for evaluating evidence, translating knowledge, and formulating recommendations for practice.










The ADA Practical Guide to Substance Use Disorders and Safe Prescribing


Book Description

Dentists have been inundated by patients with an array of complicated medical conditions and pain/sedation management issues. This is in addition to a variety of legal regulations dentists must follow regarding the storage and recordkeeping of controlled substances. Avoid unknowingly putting your practice at risk by becoming victim to a scam or violating a recordkeeping requirement with The ADA Practical Guide to Substance Use Disorders and Safe Prescribing. This Practical Guide is ideal for dentists and staff as they navigate: • Detecting and deterring substance use disorders (SUD) and drug diversion in the dental office (drug-seeking patients) • Prescribing complexities • Treating patients with SUD and complex analgesic and sedation (pain/sedation management) needs and the best use of sedation anxiety medication • Interviewing and counselling options for SUD • Federal drug regulations Commonly used illicit, prescription, and over-the-counter drugs, as well as alcohol and tobacco, are also covered. Special features include: • Clinical tools proven to aid in the identification, interviewing, intervention, referral and treatment of SUD • Basic elements of SUD, acute pain/sedation management, and drug diversion • Summary of evidence-based literature that supports what, when and how to prescribe controlled substances to patients with SUD • Discussion of key federal controlled substance regulations that frequently impact dental practitioners • Checklists to help prevent drug diversion in dental practices • Chapter on impaired dental professionals • Case studies that examine safe prescribing and due diligence




Relieving Pain in America


Book Description

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.




Measuring Alcohol Consumption


Book Description

The Importance of Measuring Alcohol Consumption To date, alcohol studies have attended far more to issues of alco hol dependence and the harmful consequences of drinking than to the level of alcohol consumption itself. This is, perhaps, not surprising since dependence on alcohol is believed to constitute a meaningful and distinct medical syndrome, regardless of the level of alcohol consumption associated with it (Edwards and Gross, 1976). Also, of society is generally more concerned with the adverse consequences drinking (e. g. , traffic fatalities, homelessness, health care and legal expenses, and academiclbehavioral problems in young drinkers), than with the quantity of alcohol actually consumed. Nevertheless, accurate assessment of alcohol usage is important in its own right in at least four contexts: 1. Evaluating the effectiveness of alcoholism and alcohol abuse treatment and prevention efforts. Such efforts include both applied evaluations of existing programs and formal, well-controlled efficacy studies on experimental interventions. These investigations require rigorous methodologies to assess outcomes precisely and contrast what may be quite subtle differences between programs and between pre treatment and posttreatment outcomes. Although these studies are usually characterized by the employment of multiple measures of success-including general improvements in social and physical functioning, reduction in degree of dependence, and resolution of problems directly resultant from drinking-it is by their assessment of changes in drinking behavior that they are potentially able to achieve the highest level of objectivity and exactitude.