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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Pain Management for People with Serious Illness in the Context of the Opioid Use Disorder Epidemic: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25435.
×

Pain Management for
People with Serious Illness
in the Context of the
Opioid Use Disorder Epidemic

PROCEEDINGS OF A WORKSHOP

Laurene Graig, India Olchefske, and Joe Alper, Rapporteurs

Roundtable on Quality Care for People with Serious Illness

Board on Health Care Services

Board on Health Sciences Policy

Health and Medicine Division

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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Pain Management for People with Serious Illness in the Context of the Opioid Use Disorder Epidemic: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25435.
×

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This activity was supported by Aetna Inc., Altarum Institute, American Academy of Hospice and Palliative Medicine, American Cancer Society, American Geriatrics Society, Anthem Inc., Ascension Health, Association of Professional Chaplains, Association of Rehabilitation Nurses, Blue Cross Blue Shield Association, Blue Cross Blue Shield of Massachusetts, Blue Cross and Blue Shield of North Carolina, Bristol-Myers Squibb, The California State University Institute for Palliative Care, Cambia Health Solutions, Cedars-Sinai Health System, Center to Advance Palliative Care, Centers for Medicare & Medicaid Services, Coalition to Transform Advanced Care, Excellus BlueCross BlueShield, Federation of American Hospitals, The Greenwall Foundation, The John A. Hartford Foundation, Hospice and Palliative Nurses Association, Kaiser Permanente, Susan G. Komen, Gordon and Betty Moore Foundation, National Coalition for Hospice and Palliative Care, National Hospice and Palliative Care Organization, National Palliative Care Research Center, National Patient Advocate Foundation, National Quality Forum, The New York Academy of Medicine, Oncology Nursing Society, Patient-Centered Outcomes Research Institute, Social Work Hospice and Palliative Care Network, Supportive Care Coalition, and the National Academy of Medicine. The MAYDAY Fund also provided support for this project. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

International Standard Book Number-13: 978-0-309-49223-2
International Standard Book Number-10: 0-309-49223-8
Digital Object Identifier: https://doi.org/10.17226/25435

Additional copies of this publication are available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.zqzwqdlvs.com.

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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2019. Pain management for people with serious illness in the context of the opioid use disorder epidemic: Proceedings of a workshop. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/25435.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Pain Management for People with Serious Illness in the Context of the Opioid Use Disorder Epidemic: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25435.
×

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The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president.

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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Pain Management for People with Serious Illness in the Context of the Opioid Use Disorder Epidemic: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25435.
×

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Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the study’s statement of task by an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process and it represents the position of the National Academies on the statement of task.

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For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/whatwedo.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Pain Management for People with Serious Illness in the Context of the Opioid Use Disorder Epidemic: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25435.
×

PLANNING COMMITTEE FOR A WORKSHOP ON PAIN MANAGEMENT FOR PEOPLE WITH SERIOUS ILLNESS IN THE CONTEXT OF THE OPIOID USE DISORDER EPIDEMIC1

ANDREW DREYFUS (Co-Chair), President and Chief Executive Officer, Blue Cross Blue Shield of Massachusetts

JAMES A. TULSKY (Co-Chair), Chair, Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute; Chief, Division of Palliative Medicine, Brigham and Women’s Hospital; Professor of Medicine and Co-Director, Center for Palliative Care, Harvard Medical School

PATRICIA A. BOMBA, Vice President and Medical Director, Geriatrics, Excellus BlueCross BlueShield

STEVE CLAUSER, Director, Healthcare Delivery and Disparities Research Program, Patient-Centered Outcomes Research Institute

REBECCA A. KIRCH, Executive Vice President of Healthcare Quality and Value, National Patient Advocate Foundation

JANE LIEBSCHUTZ, Chief, Division of General Internal Medicine, University of Pittsburgh Medical Center Health System, University of Pittsburgh School of Medicine

SALIMAH MEGHANI, Associate Professor of Nursing and Term Chair in Palliative Care, Department of Biobehavioral Health Sciences; Chair, Graduate Group in Nursing; Associate Director, NewCourtland Center for Transitions and Health; Senior Fellow, Leonard Davis Institute of Health Economics, University of Pennsylvania

R. SEAN MORRISON, Director, National Palliative Care Research Center

JUDITH PAICE, Director, Cancer Pain Program, Division of Hematology-Oncology, and Research Professor of Medicine, Feinberg School of Medicine, Northwestern University

PHILIP A. PIZZO, Founding Director, Stanford Distinguished Careers Institute; Former Dean and David and Susan Heckerman Professor of Pediatrics and of Microbiology and Immunology, Stanford University School of Medicine

___________________

1 The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Pain Management for People with Serious Illness in the Context of the Opioid Use Disorder Epidemic: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25435.
×

CHRISTIAN SINCLAIR, Outpatient Palliative Oncology Lead, Division of Palliative Medicine, University of Kansas Medical Center, representing the American Academy of Hospice and Palliative Medicine

Project Staff

LAURENE GRAIG, Director, Roundtable on Quality Care for People with Serious Illness

SYLARA MARIE CRUZ, Research Associate

RAJBIR KAUR, Senior Program Assistant

SHARYL NASS, Director, Board on Health Care Services, and Director, National Cancer Policy Forum

INDIA OLCHEFSKE, Research Associate (until June 2019)

ANDREW M. POPE, Director, Board on Health Sciences Policy

Consultant

JOE ALPER, Consulting Writer

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Pain Management for People with Serious Illness in the Context of the Opioid Use Disorder Epidemic: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25435.
×

ROUNDTABLE ON QUALITY CARE FOR PEOPLE WITH SERIOUS ILLNESS1

LEONARD D. SCHAEFFER (Chair), Judge Robert Maclay Widney Chair and Professor, University of Southern California

JAMES A. TULSKY (Vice Chair), Chair, Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute; Chief, Division of Palliative Medicine, Brigham and Women’s Hospital; Professor of Medicine and Co-Director, Center for Palliative Care, Harvard Medical School

JENNIFER BALLENTINE, Executive Director, The California State University Institute for Palliative Care

ROBERT A. BERGAMINI, Medical Director, Palliative Care Services, Mercy Clinic Children’s Cancer and Hematology, representing the Supportive Care Coalition

AMY J. BERMAN, Senior Program Officer, The John A. Hartford Foundation

LORI BISHOP, Vice President of Palliative and Advanced Care, National Hospice and Palliative Care Organization

PATRICIA A. BOMBA, Vice President and Medical Director, Geriatrics, Excellus BlueCross BlueShield

SUSAN BROWN, Senior Director, Health Education, Susan G. Komen

GRACE B. CAMPBELL, Assistant Professor, Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, representing the Association of Rehabilitation Nurses

STEVE CLAUSER, Director, Healthcare Delivery and Disparities Research Program, Patient-Centered Outcomes Research Institute

PATRICK CONWAY, President and Chief Executive Officer-Elect, Blue Cross and Blue Shield of North Carolina

DAVID J. DEBONO, Medical Director, Oncology, Anthem Inc.

CHRISTOPHER M. DEZII, Lead, Quality and Measure Development, State and Federal Payment Agencies, U.S. Value, Access and Payment, Bristol-Myers Squibb

___________________

1 The National Academies of Sciences, Engineering, and Medicine’s forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.

Page viii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Pain Management for People with Serious Illness in the Context of the Opioid Use Disorder Epidemic: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25435.
×

ANDREW DREYFUS, President and Chief Executive Officer, Blue Cross Blue Shield of Massachusetts

CAROLE REDDING FLAMM, Executive Medical Director, Blue Cross Blue Shield Association

MARK B. GANZ, President and Chief Executive Officer, Cambia Health Solutions

ZIAD R. HAYDAR, Senior Vice President and Chief Clinical Officer, Ascension Health

PAMELA S. HINDS, Director of Nursing Research and Quality Outcomes, Children’s National Health System

HAIDEN HUSKAMP, 30th Anniversary Professor of Health Care Policy, Harvard Medical School

KIMBERLY JOHNSON, Associate Professor of Medicine, Senior Fellow in the Center for the Study of Aging and Human Development, Duke University School of Medicine

CHARLES N. KAHN III, President and Chief Executive Officer, Federation of American Hospitals

REBECCA A. KIRCH, Executive Vice President of Healthcare Quality and Value, National Patient Advocate Foundation

TOM KOUTSOUMPAS, Co-Founder, Coalition to Transform Advanced Care

SHARI M. LING, Deputy Chief Medical Officer, Center for Clinical Standards and Quality, Centers for Medicare & Medicaid Services

BERNARD LO, President and Chief Executive Officer, The Greenwall Foundation

JOANNE LYNN, Director, Center for Elder Care and Advanced Illness, Altarum Institute

DIANE E. MEIER, Director, Center to Advance Palliative Care

AMY MELNICK, Executive Director, National Coalition for Hospice and Palliative Care

JERI L. MILLER, Chief, Office of End-of-Life and Palliative Care Research, and Senior Policy Analyst, Division of Extramural Science Programs, National Institute of Nursing Research, National Institutes of Health

R. SEAN MORRISON, Director, National Palliative Care Research Center

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Pain Management for People with Serious Illness in the Context of the Opioid Use Disorder Epidemic: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25435.
×

BRENDA NEVIDJON, Chief Executive Officer, Oncology Nursing Society

HAROLD L. PAZ, Executive Vice President and Chief Medical Officer, Aetna Inc.

JUDITH R. PERES, Long Term and Palliative Care Consultant, Clinical Social Worker and Board Member, Social Work Hospice and Palliative Care Network

PHILLIP A. PIZZO, Founding Director, Stanford Distinguished Careers Institute, Former Dean and David and Susan Heckerman Professor of Pediatrics and of Microbiology and Immunology, Stanford University School of Medicine

THOMAS M. PRISELAC, President and Chief Executive Officer, Cedars-Sinai Health System

JOANNE REIFSNYDER, Executive Vice President, Clinical Operations and Chief Nursing Officer, Genesis Healthcare, representing the Hospice and Palliative Nurses Association

RACHEL ROILAND, Director, Serious Illness Care Initiative, National Quality Forum

JUDITH A. SALERNO, President, The New York Academy of Medicine

DIANE SCHWEITZER, Acting Chief Program Officer, Patient Care Program, Gordon and Betty Moore Foundation

KATRINA M. SCOTT, Oncology Chaplain, Massachusetts General Hospital, representing the Association of Professional Chaplains

KATHERINE SHARPE, Senior Vice President, Patient and Caregiver Support, American Cancer Society

JOSEPH W. SHEGA, Regional Medical Director, VITAS Hospice Care, representing the American Geriatrics Society

CHRISTIAN SINCLAIR, Outpatient Palliative Oncology Lead, Division of Palliative Medicine, University of Kansas Medical Center, representing the American Academy of Hospice and Palliative Medicine

SUSAN ELIZABETH WANG, Regional Lead for Shared Decision-Making and Advance Care Planning, Southern California Permanente Medical Group, Kaiser Permanente

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Pain Management for People with Serious Illness in the Context of the Opioid Use Disorder Epidemic: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25435.
×

Roundtable on Quality Care for People with Serious Illness Staff

LAURENE GRAIG, Director, Roundtable on Quality Care for People with Serious Illness

SYLARA MARIE CRUZ, Research Associate

RAJBIR KAUR, Senior Program Assistant

INDIA OLCHEFSKE, Research Associate (until June 2019)

MICAH WINOGRAD, Financial Officer

SHARYL NASS, Director, Board on Health Care Services, and Director, National Cancer Policy Forum

ANDREW M. POPE, Director, Board on Health Sciences Policy

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Pain Management for People with Serious Illness in the Context of the Opioid Use Disorder Epidemic: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25435.
×

Reviewers

This Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process.

We thank the following individuals for their review of this proceedings:

HAILEY W. BULLS, Moffitt Cancer Center

JESSICA MERLIN, University of Pittsburgh

BOB TWILLMAN, University of Kansas School of Medicine

Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by SARA ROSENBAUM, The George Washington University. She was responsible for making certain that an independent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteurs and the National Academies.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Pain Management for People with Serious Illness in the Context of the Opioid Use Disorder Epidemic: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25435.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Pain Management for People with Serious Illness in the Context of the Opioid Use Disorder Epidemic: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25435.
×

Acknowledgments

The National Academies of Sciences, Engineering, and Medicine’s Roundtable on Quality Care for People with Serious Illness wishes to express its sincere gratitude to the Planning Committee Co-Chairs, Andrew Dreyfus and James Tulsky, for their valuable contributions to the development and orchestration of this workshop. The roundtable also wishes to thank all of the members of the planning committee, who collaborated to ensure a workshop complete with informative presentations and rich discussions. Finally, the roundtable thanks the speakers and moderators, who generously shared their expertise and their time with workshop participants.

Support from the many annual sponsors of the Roundtable on Quality Care for People with Serious Illness is critical to the roundtable’s work. The sponsors include Aetna Inc., Altarum Institute, American Academy of Hospice and Palliative Medicine, American Cancer Society, American Geriatrics Society, Anthem Inc., Ascension Health, Association of Professional Chaplains, Association of Rehabilitation Nurses, Blue Cross Blue Shield Association, Blue Cross Blue Shield of Massachusetts, Blue Cross and Blue Shield of North Carolina, Bristol-Myers Squibb, The California State University Institute for Palliative Care, Cambia Health Solutions, Cedars-Sinai Health System, Center to Advance Palliative Care, Centers for Medicare & Medicaid Services, Coalition to Transform Advanced Care, Excellus BlueCross BlueShield, Federation of American Hospitals, The Greenwall Foundation, The John A. Hartford Foundation,

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Pain Management for People with Serious Illness in the Context of the Opioid Use Disorder Epidemic: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25435.
×

Hospice and Palliative Nurses Association, Kaiser Permanente, Susan G. Komen, Gordon and Betty Moore Foundation, National Coalition for Hospice and Palliative Care, National Hospice and Palliative Care Organization, National Palliative Care Research Center, National Patient Advocate Foundation, National Quality Forum, The New York Academy of Medicine, Oncology Nursing Society, Patient-Centered Outcomes Research Institute, Social Work Hospice and Palliative Care Network, Supportive Care Coalition, and the National Academy of Medicine. The roundtable is grateful to the MAYDAY Fund for its generous support for this workshop.

Page xviii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Pain Management for People with Serious Illness in the Context of the Opioid Use Disorder Epidemic: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25435.
×
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Pain Management for People with Serious Illness in the Context of the Opioid Use Disorder Epidemic: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25435.
×

Acronyms and Abbreviations

AMA American Medical Association
CBD cannabidiol
CDC Centers for Disease Control and Prevention
CMS Centers for Medicare & Medicaid Services
DEA Drug Enforcement Administration
DSM-V Diagnostic and Statistical Manual of Mental Disorders, 5th Edition
FDA Food and Drug Administration
HHS U.S. Department of Health and Human Services
IOM Institute of Medicine
MAT medication-assisted treatment
NGA National Governors Association
NIH National Institutes of Health
NOWS neonatal withdrawal syndrome
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Pain Management for People with Serious Illness in the Context of the Opioid Use Disorder Epidemic: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25435.
×
OPR opioid pain reliever
PDMP prescription drug monitoring program
PQ-MSAS PediQUEST Memorial Symptom Assessment Scale
SAMHSA Substance Abuse and Mental Health Services Administration
STORM Stratification Tool for Opioid Risk Management
VA U.S. Department of Veterans Affairs
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Pain Management for People with Serious Illness in the Context of the Opioid Use Disorder Epidemic: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25435.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Pain Management for People with Serious Illness in the Context of the Opioid Use Disorder Epidemic: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25435.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Pain Management for People with Serious Illness in the Context of the Opioid Use Disorder Epidemic: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25435.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Pain Management for People with Serious Illness in the Context of the Opioid Use Disorder Epidemic: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25435.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Pain Management for People with Serious Illness in the Context of the Opioid Use Disorder Epidemic: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25435.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Pain Management for People with Serious Illness in the Context of the Opioid Use Disorder Epidemic: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25435.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Pain Management for People with Serious Illness in the Context of the Opioid Use Disorder Epidemic: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25435.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Pain Management for People with Serious Illness in the Context of the Opioid Use Disorder Epidemic: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25435.
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The United States is facing an opioid use disorder epidemic with opioid overdoses killing 47,000 people in the U.S. in 2017. The past three decades have witnessed a significant increase in the prescribing of opioids for pain, based on the belief that patients were being undertreated for their pain, coupled with a widespread misunderstanding of the addictive properties of opioids. This increase in prescribing of opioids also saw a parallel increase in addiction and overdose. In an effort to address this ongoing epidemic of opioid misuse, policy and regulatory changes have been enacted that have served to limit the availability of prescription opioids for pain management.

Overlooked amid the intense focus on efforts to end the opioid use disorder epidemic is the perspective of clinicians who are experiencing a significant amount of daily tension as opioid regulations and restrictions have limited their ability to treat the pain of their patients facing serious illness. Increased public and clinician scrutiny of opioid use has resulted in patients with serious illness facing stigma and other challenges when filling prescriptions for their pain medications or obtaining the prescription in the first place. Thus clinicians, patients, and their families are caught between the responses to the opioid use disorder epidemic and the need to manage pain related to serious illness.

The National Academies of Sciences, Engineering, and Medicine sponsored a workshop on November 29, 2018, to examine these unintended consequences of the responses to the opioid use disorder epidemic for patients, families, communities, and clinicians, and to consider potential policy opportunities to address them. This publication summarizes the presentations and discussions from the workshop.

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