AMA Fact Sheet on Hydrocodone Rescheduling

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WHO GUIDELINES ON NALOXONE AVAILABILITY

New guidelines recommending expanded access to the drug naloxone (multiple brands) to reduce the number of opioid-related deaths globally have been released by the World Health Organization (WHO). The guidelines recommend that countries expand community access to the drug and provide training to individuals likely to witness an overdose in their community, including social workers and friends, family members, and partners of individuals who use opioids, so they can respond to an overdose if emergency medical response is unavailable.

The WHO notes that nalaxone, which has been used in the management of opioid overdose for more than 40 years, is “a safe drug with a low risk of serious side effects” and that “any adult capable of learning basic life support can also learn to recognize an opioid overdose, and administer naloxone in time to save lives.”

According to the WHO, in most countries, naloxone is accessible only through hospitals and ambulance crews. It also notes that although naloxone can save lives when administered by bystanders, it should not be seen as a replacement for comprehensive medical care.

It is estimated that globally, 69,000 people die each year from opioid overdose. Among individuals who inject drugs, opioid overdose is the second most common cause of death after HIV/AIDS.

In an editorial published in the British Medical Journal, John Strang, MBBS, FRCPsych, MD, National Addiction Centre, Institute of Psychiatry and the Maudsley, King's College London, United Kingdom, and colleagues note that although more research is vital, “take-home” access to naloxone, as recommended by the WHO, will help save lives. They point out that of nearly 3,000 drug-related deaths registered in England in 2013, 56% involved opioids. Last month, Scotland (the first country to introduce a national program to provide naloxone) released results showing a marked reduction in opioid overdose deaths among people just released from prison (a group at particularly high risk) from 9.8% (193/1970) in 2006 to 4.7% (18/383) in 2013.

Schemes to make naloxone available are being implemented around the world, explain the authors. They note that Scotland and Wales both launched national take-home naloxone programs in 2011. They also point out that city and state schemes have recently been started in parts of North America, Europe, and Australia. Various countries have also clarified the legal status of resuscitation actions by members of the public, including administration of naloxone, with the intention of saving life.

The authors suggest that patients at high risk for death from overdose should carry emergency naloxone “especially at times when contact with treatment or care is associated with transient increased risk.” Dr. Strang and colleagues note that more research is needed to determine optimal dose and comparative routes of administration and to explore better mechanisms for wider use of naloxone. However, they add, “these studies are vital, but they must not delay implementation. While we dither, people will die from overdose.”

World Health Organization. Community Management of Opioid Overdose  is accessible on-line at: http://www.who.int/substance_abuse/publications/manage-ment_opioid_overdose/en.

SUPPORT FOR BREATHLESSNESS MAY IMPROVE QUALITY OF LIFE AND SURVIVAL

A report published on-line on October 29, 2014 in Lancet Respiratory medicine indicates that patients who have a support service for their breathlessness may live better and longer.

“Background breathlessness is a common and distressing symptom, which increases in many diseases as they progress and is difficult to manage,” said lead author Dr. Irene J. Higginson, professor of palliative care at King's College London and director of the Cicely Saunders Institute in London.

“This study is the first to test earlier, integrated palliative care in noncancer as well as cancer patients. We found that the integrated service, focused on patients with breathlessness at rest and with minimal exertion, led to better quality of life and survival rates for patients with lung disease and cancer,” she told Reuters Health by email.

The investigators randomly assigned 105 patients to a breathlessness support service (BSS) or usual care, balancing the numbers of patients in each group for the potential confounders of cancer versus noncancer, breathlessness severity, presence of an informal caregiver and ethnicity. The short-term, single-point-of-access BSS integrated palliative care, respiratory medicine, and physical and occupational therapy. Interviewers were blinded as to the group in which each subject was assigned. At six weeks, the investigators documented patient-reported breathlessness mastery, a quality-of-life domain in the Chronic Respiratory Disease Questionnaire. More than three-quarters of the patients completed this assessment. Mastery in the BSS group improved significantly compared with the control group (mean difference 0.58, p = 0.048), and sensitivity analysis confirmed the results. In the BSS group, 50 of 53 patients were alive at six months compared with 39 of 52 in the control group (94% vs. 75%, p = 0.048).

“Patients who received the new service had improved quality of life, with BSS patients scoring 16% higher in breathlessness mastery, which assessed their feeling of control over breathlessness and its effects on their quality of life and function,” Dr. Higginson said.

“It would be possible for doctors to provide this low-cost intervention with a palliative medicine specialist, respiratory services including respiratory medicine, physiotherapy and occupational therapy if possible, and a place to hold a clinic where these services would work together,” she added.

ALLIANCE FOR BALANCED PAIN MANAGEMENT SUPPORTS PAIN MANAGEMENT AND RESPONSIBLE DRUG USE

On November 20, 2014, a diverse collective of health care advocacy groups, patient organizations, industry representatives, and other stakeholders today announced they have established the Alliance for Balanced Pain Management (AfBPM) to support appropriate access to integrated pain management and responsible use of prescription pain medicines with an aim to reduce abuse. AfBPM will work collaboratively to educate, support, and advocate on behalf of people affected by pain, both acute and chronic. The multimedia assets including broadcast-quality video and photos can be accessed on-line at: http://www.multimedianewscenter.com/allianceforb-alancedpainmanagement/alliance-for-balanced-pain-management-launch

The Institute of Medicine has stated that chronic pain affects an estimated 100 million Americans and an untold number of people are affected by acute pain.¹ Important attention is being given to the rise in abuse, misuse, and diversion of prescription pain medications, yet many people still receive inadequate pain assessment and treatment.¹ According to a recent report issued by the National Institutes of Health, 40% to 70% of people with chronic pain are not receiving proper medical treatment.² Proper medical treatment can include physical therapy and rehabilitation, psychological counseling, social support, medication, and other complementary approaches.

AfBPM is composed of 22 organizations including a steering committee made up of the Alliance for Patient Access, the American Cancer Society, the American Chronic Pain Association, Mallinckrodt Pharmaceuticals, the Partnership for Drug-Free Kids and The Gerontological Society of America.

AfBPM formally launched following a 2-day Summit held on November 18 and 19, 2014 that focused equally on how to help ensure people with pain receive the care they need while also countering abuse, misuse and diversion of prescription medicine.

GOALS OF THE ALLIANCE INCLUDE THE FOLLOWING

• Ensure people with or affected by pain have appropriate access to integrated, effective, and safe care, such as physical therapy and rehabilitation, psychological counseling, social support, medication, and other complementary approaches.

• Reinforce the critical need to safely prescribe, dispense, take, store, and dispose of prescription medications with an aim to reduce abuse, misuse, and diversion.

• Support organizations and individuals who share a common goal to reduce pain, improve care, and advocate for responsible use of medicine.

• Share tools and materials for its members to educate their constituents and the public about integrated pain management strategies and responsible use of medicine.

AfBPM defines balanced pain management as a comprehensive approach to diagnosing, treating, and controlling pain. It uses a multi-pronged and individualized treatment plan to coordinate safe and effective options that can address the physical, emotional, social, and psychological aspects of pain. In a balanced approach to pain management, people with pain, along with family members and caregivers, learn to manage their pain in safe, effective, responsible, and healthy ways to improve or maintain their overall well-being. Components may include physical therapy and rehabilitation, medication, psychological counseling, and social support. When medications are necessary, there must be full recognition of potential side effects and appropriate management of the medications. Equally important, there must also be a commitment to safely use, store and dispose of such medications, if prescribed, as part of the pain management plan.

AFBPM STEERING COMMITTEE MEMBER STATEMENTS INCLUDE THE FOLLOWING

Alliance for Patient Access (AfPA), Sri Nalamachu, MD, Chair, Pain Therapy Access Physicians Working Group: “As a network of physicians dedicated to ensuring patient access to approved therapies and appropriate clinical care, we are committed to working with AfBPM members to increase awareness of the important issues in pain management. We support efforts to ensure that people who experience pain receive appropriate relief, including a broad spectrum of integrated treatment approaches to minimize their pain and, if pain medication is required, it is prescribed, used, stored, and discarded appropriately and responsibly. No one should feel stigmatized for seeking legitimate pain relief.”

American Cancer Society, Rebecca Kirch, Director, Quality of Life and Survivorship:

“Pain often is a consequence of cancer and cancer treatments, and unrelieved pain can significantly impair a patient's daily functioning, emotional well-being, and overall quality of life, which may affect their ability to fight their cancer. We joined AfBPM to ensure that people who suffer from pain, in particular people with cancer who may have unique concerns and treatment-related issues, receive the comprehensive pain management and educational tools they need, and that pain medications, if prescribed, are taken and disposed of properly to reduce potential abuse.”

American Chronic Pain Association, Penney Cowan, Founder and Executive Director:

“People with chronic pain have highly individual needs. An integrated, multidisciplinary approach that takes into account the person's own unique circumstances, needs and goals and encourages the person to take an active role in his or her recovery process, is essential for effective pain management and well-being. We support efforts to foster awareness of balanced pain management, including access and accountability, and look forward to working with our AfBPM partners on these important initiatives.”

Mallinckrodt Pharmaceuticals, Mario Saltarelli, MD, PhD, Senior Vice President and Chief Science Officer: “Mallinckrodt is dedicated to providing safe and effective medications for the treatment of people who experience pain and equally committed to fighting the problems of prescription pain medication misuse and abuse. We are proud to support a broad range of programs and efforts, including AfBPM, to drive access to appropriate, integrated pain management, the responsible use of medicines as prescribed and their safe disposal.”

Partnership for Drug-Free Kids, Marcia Lee Taylor, Senior Vice President for Government Affairs: “The Partnership for Drug-Free Kids is committed to preventing teens from abusing medicine. With two thirds of teens who abuse pain relievers reporting that they get them from families and friends, we know the importance of reducing the ready availability of these pills in America's medicine cabinets and getting adults to “Mind their Meds.” As part of AfBPM, we will work to foster discussion around responsible use, as well as storage and disposal of pain medications. Our programs aim to keep medicines out of the hands of our youth to reduce medication abuse, while supporting access to pain medication for people who legitimately need it.”

The Gerontological Society of America, James Appleby, RPh, MPH, Executive Director and Chief Executive Officer: “The complexity of assessing and treating pain in the aging population requires a multidisciplinary approach. At times, drug therapy may be necessary to control pain among older adults, but is not without its risks, such as drug interactions and the potential for abuse. The Gerontological Society of America is pleased to be part of AfBPM to bring greater attention to pain management among the aging population, ensure aging Americans have access to appropriate care and that they are aware of and take action to help mitigate potential abuse.”

The Alliance for Balanced Pain Management Member Organizations are as follows.

Table

The Alliance for Balanced Pain Management is committed to fostering public dialogue and action to ensure people with pain have access to appropriate, effective, and safe-integrated pain management and that medications, if prescribed, are used, stored, and disposed of in a safe and responsible manner with an aim to reduce abuse, misuse, and diversion. It is composed of diverse advocacy groups, patient organizations, industry, and other stakeholders. Mallinckrodt Pharmaceuticals is the founding sponsor. Public or private organizations that are focused on addressing and advancing balanced pain management, reinforcing the need for safe and responsible prescribing, use, storage and disposal of prescription pain medications, and minimizing misuse of prescription pain medication may join the Alliance for Balanced Pain Management. Find out more about AfBPM and membership: www.AllianceBPM.org.

CALIFORNIA FOUNDATION PUBLISHES GUIDE TO PALLIATIVE CARE PROGRAMS

The California HealthCare Foundation released its new report “Up Close: A Field Guide to Community-based Palliative Care in California.” The report describes common approaches and characteristics of the programs, the challenges they faced, and the promising practices they have developed, as well as opinions of experts. It includes information about staffing composition and volume, and presents case studies. The foundation intends for the guide to be used by providers interested in starting new community-based palliative care programs or strengthening or expanding existing ones. The full report can be accessed by cutting and copying the following URL into a web browser: http://www.chcf.org/∼/media/MEDIA%20LIBRARY%20Files/PDF/U/-PDF%20UpCloseFieldGuidePalliative.pdf.

WASHINGTON POST LAUNCHES COMPARISON WEBSITE FOR MEDICARE-CERTIFIED HOSPICES

The Washington Post cast a critical eye on the hospice industry this year through a series of articles entitled “The Business of Dying”. The Post has now launched the Consumer Guide to Hospice. The comparison website presents data largely from government sources on more than 3,000 hospices that participate in Medicare, with the goal of allowing consumers to compare facilities based on criteria that include size, accreditation, years in business, ownership, crisis care, and spending per-day on patient care. “While not comprehensive, the guide includes measures that experts say can help gauge the quality of care,” the Post wrote. The full guide can be accessed on line at: http://www.washingtonpost.com/wp-srv/special/business/hospice-quality/

In an accompanying article, the paper said the website was needed because Medicare offers comparison sites for hospitals and nursing homes, but not for hospices—and that such consumer information would not be forthcoming until at least 2017.

END-OF-LIFE COSTS LOWERED FOR HOSPICE-ENROLLED MEDICARE PATIENTS

Medicare beneficiaries who were receiving hospice care were admitted to the hospital at a lower rate than matched controls, according to a recent study published in The Journal of the American Medical Association; Obermeyer Z, Makar M, Abujaber S, Dominici F, Block S, Cutler DM. Association Between the Medicare Hospice Benefit and Health Care Utilization and Costs for Patients With Poor-Prognosis Cancer.

Those patients also experienced fewer invasive procedures and fewer intensive care admissions. Costs in the last year of life were $8,697 lower in the hospice cohort than the nonhospice cohort. The investigators used a nationally representative sample of 86,851 Medicare fee-for-service beneficiaries with poor-prognosis cancers to assess health care use and cost in those enrolled in hospice, and those who were not.

UNIVERSITY OF WASHINGTON PALLIATIVE CARE CENTER OF EXCELLENCE FUNDED

On December 3, 2014, the Cambia Health Foundation announced that it will provide a $10 million gift to UW Medicine for its Palliative Care Center of Excellence, a gift that will secure the future of the center. The center will be renamed the Cambia Palliative Care Center of Excellence this December. The Cambia Palliative Care Center of Excellence will employ research and education to improve quality of life for patients who need palliative care: those at the end of life as well as patients with serious illnesses, chronic conditions or traumatic injuries.

Cambia Health Foundation is the corporate foundation of Cambia Health Solutions, a total health solutions company dedicated to transforming the way people experience health care. The foundation has supported the advancement of palliative care since 2009. This gift is the foundation's largest investment to date, bringing total funding for regional and national palliative care programs and initiatives to just over $22 million.

“The Cambia Palliative Care Center for Excellence at UW Medicine has quickly become a role model for best practices in palliative care education, metrics, and implementation, and we are proud of our ongoing partnership,” said Peggy Maguire, president and board chair of the Cambia Health Foundation. “This investment underscores our belief that, together, the foundation and the Cambia Palliative Care Center for Excellence will be a catalyst for growth and innovation in the field of palliative medicine, both regionally and nationally.”

This transformative investment at UW Medicine will be used to create three endowments totaling $8 million, which will support research, education and training, and clinical leadership in perpetuity. An additional $2 million will enable the center to have an immediate impact on improving care. The center's goal is to see that palliative care has an integral and prominent role in healthcare—regionally, nationally, and internationally—for seriously ill patients and their families. “The Cambia Health Foundation has provided truly visionary support for palliative care,” says Paul G. Ramsey, M.D., the CEO of UW Medicine. “Their belief in our work has allowed us to succeed, and we are enormously grateful for their partnership in enhancing research, education and excellent patient-centered palliative care programs at UW Medicine.”

RESUSCITATING THE BIOPSYCHOSOCIAL MODEL

The biopsychosocial model is important in pain management. This perspective on symptom control applies in other areas of health care as well. An article in the recently introduced The Lancet Psychiatry addresses this approach.

A reductionist biological model cannot be merely replaced with a purely reductionist psychosocial model according to prominent US psychiatrist Allen Frances, who chaired the DSM-IV task force, argues for a balanced approach to mental health care. Reference: The Lancet Psychiatry, Volume 1, Issue 7, Pages 496–497, Dec 2014

PRIMARY CARE DOCTORS REPORT PRESCRIBING FEWER OPIOIDS FOR PAIN

On December 8, the Johns Hopkins Bloomberg School of Public Health reported that overdose death rates in the United States have more than tripled since 1990 and have never been higher. The clinical use of prescription opioids nearly doubled between 2000 and 2010. In 2010, more than 38,000 people died from drug overdoses of all kinds, with many of these deaths caused by prescription opioids.

Only in recent years has the medical community paid much attention to the mounting epidemic, the researchers say. For their research, Alexander and his colleagues sent surveys in February 2014 to a nationally representative sample of 1,000 U.S. internists, family physicians and general practitioners, with 58% responding. Among the findings: A large majority of the respondents—85%—say they believe that opioids are overused in clinical practice. Many reported they are “very” or “moderately” concerned about serious risks such as addiction (55% reporting “very concerned”), death (48%), and motor vehicle crashes (44%) that may be associated with opioid overuse. Many also reported they believe that adverse events, such as tolerance (62%) and physical dependence (56%) occur “often,” even when the medications are used as directed for chronic pain.

Surprisingly, despite concerns about overprescribing, nearly all physicians surveyed (88%) expressed confidence in their own ability to prescribe opioids appropriately. Such attitudes may reflect the fact that doctors tend to perceive their own clinical skills and judgment as superior to that of their peers. For example, physicians’ “ego bias” has been demonstrated in the setting of engagements with pharmaceutical manufacturers. Prior studies have shown that most doctors believe their colleagues’ prescribing decisions are swayed by pharmaceutical marketing and promotion, yet they themselves are immune to such effects.

Alexander says he hopes more physicians and patients look toward more nonopioid treatments for pain, such as other types of pain relievers and nondrug treatments including physical therapy, massage, and acupuncture.

Meanwhile, he says more research is needed. While there is good value in surveying physicians about their attitudes, beliefs, and experiences, he says research using pharmacy data is needed to confirm the degree to which prescribers’ reliance on prescription opioids is actually decreasing.

“Prescription Drug Abuse: A National Survey of Primary Care Physicians” was written by Catherine S. Hwang, MSPH; Lydia W. Turner, MHS; Stefan P. Kruszewski, MD; Andrew Kolodny, MD; and G. Caleb Alexander, MD, MS.

Hwang is an ORISE Fellow at the FDA. Kruszewski has served as a general and case-specific expert for multiple plaintiff litigations involving OxyContin, Neurontin, and Zyprexa and has had false claims settled as co-plaintiff with the United States against Southwood Psychiatric Hospital, Pfizer (Geodon), and AstraZeneca (Seroquel). Kolodny is chief medical officer at Phoenix House and director of Physicians for Responsible Opioid Prescribing. Alexander is chair of the FDA's Peripheral and Central Nervous System Drugs Advisory Committee, serves as a paid consultant to IMS Health, and serves on an IMS Health scientific advisory board. This arrangement has been reviewed and approved by the Johns Hopkins University in accordance with its conflict of interest policies.

The research was supported by the Robert Wood Johnson Foundation Public Health Law Research Program and the Lipitz Public Health Policy Fund Award from the Johns Hopkins Bloomberg School of Public Health.

DYING IN AMERICA-IMPROVING QUALITY AND HONORING INDIVIDUAL PREFERENCES NEAR THE END-OF-LIFE

Dying in America is a consensus report from the Institute of Medicine (IOM), written by a committee of experts which found that improving the quality and availability of medical and social services for patients and their families could not only enhance quality of life through the end of life, but may also contribute to a more sustainable care system. For patients and their loved ones, no care decisions are more profound than those made near the end of life. For the millions of Americans who work in or with the health care sector—including clinicians, clergy, caregivers, and support staff—providing high-quality care for people who are nearing the end of life is a matter of professional commitment and responsibility. Health system managers, payers, and policy makers, likewise, have a responsibility to ensure that end-of-life care is compassionate, affordable, sustainable, and of the best quality possible.

A SUBSTANTIAL BODY OF EVIDENCE SHOWS THAT BROAD IMPROVEMENTS TO END-OF-LIFE CARE ARE WITHIN REACH

A number of factors make the IOM study particularly timely, including the rapidly increasing number of older Americans with some combination of frailty, physical, and cognitive disabilities, chronic illness, and functional limitations. The U.S. population also is quickly becoming more culturally diverse, heightening the need for responsive, patient-centered care. In addition, the nation's health care system is increasingly burdened by factors that hamper delivery of high-quality care near the end of life, including

• barriers in access to care that disadvantage certain groups;

• a mismatch between the services patients and families need and the services they can obtain; Improving the quality and availability of medical and social services for patients and their families could not only enhance quality of life through the end of life, but may also contribute to a more sustainable care system.

• inadequate numbers of palliative care specialists and too little palliative care knowledge among other clinicians who care for individuals with serious advanced illness; and

• a fragmented care delivery system, spurred by perverse financial incentives, that contributes to the lack of service coordination across programs and unsustainable growth in costs.

• Although the systems that support people at the end of life face increasing challenges and strain, there are new and encouraging opportunities for improvement. For example, there is growing knowledge within medical and social care communities about how to better engage patients and families in advance care planning and shared decision making, including seriously ill children and adolescents who may be able to participate in their own end-of-life care decisions. Other promising opportunities to improve care include utilization of new communications technologies, growing recognition and support for family caregivers, and the development of quality measures to increase accountability. Finally, according to the IOM committee, the greatest potential for positive change may lie in health care system reforms that affect the organization and financing of health services.

The committee makes recommendations in the areas of care delivery, clinician—patient communication and advance care planning, professional education and development, payment systems and policies, and public engagement and education.

Ideally, health care should harmonize with social, psychological, and spiritual support to achieve the highest possible quality of life for people of all ages with serious illnesses or injuries. Toward this end, the IOM committee recommends that integrated, person-centered, family-oriented, and consistently accessible care near the end of life be provided by health care delivery organizations and covered by government and private health insurers.

The committee finds that a palliative approach typically affords patients and families the highest quality of life for the most time possible. For the purposes of the report, the committee defines palliative care as that which provides relief from pain and other symptoms, supports quality of life, and is focused on patients with serious advanced illness and their families. Palliative care may begin early in the course of treatment for a serious condition. Hospice is an important approach to addressing the palliative care needs of patients with limited life expectancy and their families. For people with a terminal illness or at high risk of dying in the near future, hospice is a comprehensive, socially supportive, pain-reducing, and comforting alternative to technologically elaborate, medically centered interventions. It therefore has many features in common with palliative care.

Although palliative care is well established in most large hospitals and professional education programs, the committee identifies the need for greater understanding of the role of palliative care—by both the public and care professionals—as one of the greatest remaining challenges in the delivery of high-quality end-of-life care.

Many people nearing the end of life may not be physically or mentally capable of making their own care decisions. In addition, family members and clinicians may not be able to accurately guess what a person's care preferences may be. Therefore, advance care planning is critically important to ensure that patients’ goals and needs are met. Although advance directive documents can be useful, they should allow health care agents and care providers to make informed decisions in certain circumstances and should not take the place of open, continuous communication. According to the IOM committee, the advance care planning process can begin at any age or state of health and should center on frequent conversations with family members and care providers. Electronic storage of advance directives, statements of wishes, or other relevant materials holds promise for improving access to and effectiveness of these materials. Professional societies and other organizations that establish quality standards should develop standards for clinician–patient communication and advance care planning. Payers and health care delivery organizations should adopt these standards as a necessary component of high-quality care for individuals with advanced serious illness and their families and enable them to seek these services from their physicians and providers.

The education of health professionals who provide care to patients at the end of life has substantially improved in recent decades. Hospice and palliative care is now an established medical specialty, and palliative care has a strong presence in clinical education, professional organizations, and research communities. However, the IOM committee finds that important deficiencies persist. First, recent knowledge gains have not necessarily translated to improved patient care. Second, the supply of palliative care and hospice specialists is small, meaning that many patients must rely on other clinicians who provide care for individuals with serious advanced illness but who may lack training and experience necessary to meet their patients’ palliative care needs. The committee recommends that educational institutions, professional societies, accrediting organizations, certifying bodies, health care delivery organizations, and medical centers take measures to both increase the number of palliative care specialists and expand the knowledge base for all clinicians.

Sustainable improvements in the organization and financing of end-of-life care must take into account the need to stabilize health care costs over time. The IOM committee finds that reform is needed in how resources for care provided near the end of life are organized. Current financial incentives encourage a reliance on acute care settings that often are costly and poorly suited to the needs, goals, and preferences of patients and their families. The committee recommends a major reorientation of payment systems to incentivize the integration of medical and social services, the coordination of care across multiple care settings, and the use of advance care planning and shared decision making to better align the services patients receive with their care goals and preferences. This reorientation will improve access to services that better respond to the needs of patients and their loved ones and may also help stabilize health care costs.

The IOM committee identifies a need for public education and engagement about end-of-life care planning at several levels:

• the societal level, to build support for public and institutional policies that ensure high-quality, sustainable care;

• the community and family levels, to raise awareness and elevate expectations about care options, the needs of caregivers, and the hallmarks of high-quality care; and

• the individual level, to motivate and facilitate advance care planning and meaningful conversations with family members and caregivers.

Although Americans’ values and opinions about end-of-life care will necessarily differ, the committee emphasizes the importance of disseminating accurate information so that individual care decisions and public dialogue, as much as possible, are based on an informed understanding of facts.

The IOM committee believes a person-centered, family-oriented approach that honors individual preferences and promotes quality of life through the end of life should be a national priority. Dying in America provides a comprehensive assessment of the knowledge gaps, structural problems, and financial disincentives that hamper delivery of optimal care and makes cross-sectoral recommendations to achieve compassionate, affordable, sustainable, and effective care for all Americans.

OPIOID PRESCRIBING SAFETY PROGRAM SCOPE OF PAIN

Boston University School of Medicine (BUSM) is offering SCOPE (Safe and Competent Opioid Prescribing Education) of Pain, a series of continuing medical education and continuing nursing education activities. They include live, half-day conferences and online education about safely prescribing opioid medications—including state-specific information—taught by faculty members specializing in pain and addiction management. The website also offers free access to opioid-related professional guidelines, and an opportunity to ask faculty members content-related questions. Funding for SCOPE of Pain comes from the Extended-Release and Long-Acting Opioid Analgesics Risk Evaluation and Mitigation Strategy Program Companies, a group of ER/LA drug developers focused on implementing a single shared REMS. For additional information and access to the program, see: https://www.scopeofpain.com.

POTENTIAL OF POLICY TO IMPROVE THE HEALTH OF AN AGING AMERICA: FOCUS ON PAIN

A special publication from the Gerontological Society of America aims to ensure that researchers, practitioners, educators, and policy makers are aware of major policy issues at federal, state, and local levels that impact the prevention, assessment, and treatment of pain, as well as the social and practical supports required by older adults with pain. This From Policy to Practice publication explores pain as a public health problem and takes a look at how various policies impact the care that is provided to patients in a range of practice settings. It also provides readers with an overview of provisions of the Affordable Care Act that address pain research, education, training, and clinical care, as well as steps taken to implement those provisions.

We believe that this inaugural issue in our From Policy to Practice series will assist you in better understanding the complex interplay between policy and clinical care for older adults with pain, who are often vulnerable and in need of multifaceted interventions and supports. This publication was developed by GSA and supported by Purdue Pharma.  It is accessible at no charge from the following URL: https://www.geron.org/component/hikashop/product/17-from-policy-to-practice-an-interdisciplinary-look-at-the-potential-of-policy-to-improve-the-health-of-an-aging-america-focus-on-pain?Itemid = 385.

CONSUMER REPORTS, NHPCO DEVELOP FREE GUIDE TO PALLIATIVE CARE

Consumer Reports has released “Palliative and Hospice Care: Comfort during a Serious Illness or the Final Months of Life,” a free guide for patients that was developed with the National Hospice and Palliative Care Organization (NHPCO). The guide, which has been published in English and Spanish, is available at the magazine's new online caregiving web portal. Also available at the portal are other materials for patients and their caregivers, including articles from the magazine, videos, and tips for obtaining the best care. To access the guide, see: http://consumerhealth-choices.org/wp-content/uploads/2014/10/Palliative-CareNHPCO-ER.pdf.

Declaration of Interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.