Confronting Pain Management and the Opioid Epidemic

The opioid crisis lies at the intersection of two public health challenges: reducing the burden of suffering from pain, and containing the rising toll of harms related to opioid use.

Millions of Americans experience pain each year. Chronic, or long-term, pain is associated with serious health problems, such as depression, and social problems, such as decreased work productivity. While opioids are effective for managing short-term pain, cancer pain, and pain at the end of life, it is not clear that opioids benefit people with chronic pain.

Using opioids long-term is associated with greater health risks. Rates of opioid use disorder (addiction to prescription opioids), overdose, and other related harms have risen with greater availability of opioids over the past two decades, even as opioid prescribing is declining in recent years. In fact, drug overdose—mostly linked to opioids—is now the leading cause of unintentional injury deaths in the United States.

It will take years of sustained and coordinated effort to contain the current opioid epidemic and stem its harmful effects on society.

The Committee’s Assignment

Recognizing the magnitude of the opioid crisis, in March 2016, the U.S. Food and Drug Administration (FDA) asked the National Academies of Sciences, Engineering, and Medicine to convene an ad hoc committee to

  • update the state of the science on pain research, care, and education since publication of the 2011 Institute of Medicine (IOM) report Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research, including the evolving role of opioids in pain management;
  • characterize the epidemiology of the opioid epidemic and the evidence on strategies for addressing it;
  • identify actions the FDA and other organizations can take to respond to the epidemic, with a particular focus on the FDA’s development of a formal method for incorporating individual and societal considerations into its risk-benefit framework for opioid approval and monitoring; and
  • identify research questions that need to be addressed to assist the FDA in implementing this framework.

A constellation of policies, interventions, and tools related to lawful access to opioids and clinical decision making

These recommendations can help reduce or contain opioid-related harms while meeting the needs of patients with pain.


Few communities have been left untouched by the opioid epidemic, and based on current trends, premature deaths are likely to keep increasing. Without urgent action, overdose and other opioid-related harms will continue to dramatically reduce quality of life for many people for years to come.

Expanding access to treatment for opioid use disorder and preventing overdose deaths should be a public health priority. It will take a sustained, coordinated effort by the nation’s political and public health leadership and a broad array of stakeholders to effectively confront the harms of the opioid epidemic affecting people, families, and society.

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