Summary s-1
1 introduction 1-1

PART I Pain management and research
2 Pain management and the intersection of pain and opioid use disorder 2-1
• The scope of the problem of pain, 2-1
• Opioid analgesics, 2-4
• Nonopioid pharmacologic treatments, 2-16
• Interventional pain therapies, 2-25
• Nonpharmacologic treatments, 2-27
• Differences in pain experiences and treatment effectiveness among
• Subpopulations, 2-33
• The intersection between pain and opioid use disorder, 2-36
• References, 2-36

3 Progress and future directions in research on pain and opioid use disorder 3-1
• Basic pain research, 3-1
• The neurobiology of the reward pathway and the intersection of pain and opioid
• Use disorder, 3-10
• Preclinical and translational research, 3-13
• Clinical research, 3-18
• Intersection of pain and opioid use disorder, 3-26
• Support for research, 3-33
• Summary and recommendation, 3-34
• References, 3-34

PART II Addressing the opioid epidemic
4 Trends in opioid use, harms, and treatment 4-1
• Trends in prescription opioid use and misuse, 4-1
• Heroin use and its relation to prescription opioid use, 4-15
• Illicit opioid markets, 4-25
• The current state of surveillance systems, 4-32
• Recent developments in pharmaceutical treatment of opioid use disorder, 4-35
• Trends in treatment of opioid overdose with naloxone, 4-46
• Summary and recommendations, 4-48
• References, 4-49

5 Evidence on strategies for addressing the opioid epidemic 5-1
• Nature of the Evidence, 5-2
• The Need for a Systems Approach, 5-4
• Strategies for Restricting Supply, 5-10
• Strategies for Influencing Prescribing Practices, 5-21
• Strategies for Reducing Demand, 5-39
• Strategies for Reducing Harm, 5-46
• Summary and Recommendations, 5-58
• References, 5-60

6 Opioid approval and monitoring by the U.S. Food and drug administration 6-1
• Overview of the FDA’s regulatory process for prescription drugs and its application to opioids, 6-2
• Public health dimensions of FDA drug regulation, 6-17
• Key elements of an integrated decision-making framework for opioid
• Regulation,6-22
• Implementation of an integrated framework for opioid regulation, 6-25
• Summary and recommendations, 6-40
• References, 6-44
• Annex table 6-1: extended-release(er)/long-acting (la) opioid post-marketing
• Study requirements, 6-49

Appendixes
A Data sources and methods a-1
B Biographical sketches of committee members and consultants b-1
C Existing data sources on opioid use, misuse, overdose, and other harms c-1

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