NASEM: Pain and Symptom Management for People with Serious Illness in the Context of the Opioid Epidemic: A Workshop


On November 29, 2018, the National Academies of Sciences, Engineering, and Medicine’s Roundtable on Quality Care for People with Serious Illness hosted a public workshop, Pain and Symptom Management for People with Serious Illness in the Context of the Opioid Epidemic. The workshop aims to explore the tension between efforts to address the opioid epidemic and the resulting impact on access to pain medications for people facing serious illness. The workshop examined the unintended consequences of the responses to the opioid epidemic for patients, families, communities, and clinicians, and consider potential policy opportunities to address them. 

The workshop included:

  • An opening session to provide context with an overview of the scope and severity of the opioid epidemic.

  • The second session on how responses to the epidemic affect the ability of people with serious illness to access opioid medications for pain and symptom management. Speakers addressed clinicians’ perspectives on their ability to effectively treat their patients’ pain and symptoms, and also discussed disparities in access to pain medications, as well as issues related to pain management for seriously ill infants and children.  

  • The pain and symptom management needs of those with co-morbid substance use disorder and serious illness was examined in the workshop’s third session.

  • Policy and regulatory responses to the opioid epidemic, including federal and state regulatory policy as well as payment policy, was the focus of the fourth session. Speakers discussed measures that have been developed and implemented to address the epidemic and whether those measures have been sufficiently flexible to limit unintended consequences for those with serious illness. Policies to expand access to non-opioids for pain and symptom management were examined, as well as associated coverage and reimbursement policies.

  • The final session of the workshop charted a path forward by identifying actionable next steps toward a solution by focusing on areas such as improving professional medical education to better prepare clinicians to treat and manage pain and addiction, enhancing the development of and access to alternatives to opioids, and expanding access to treatment for substance use disorder.

  • The workshop was presented as a live webcast on the National Academy webpage