Last updated: May 17, 2023
The National Academy of Medicine (NAM) takes very seriously the issues raised in New York Times articles on April 23 and April 28 about donations by the Sackler family to the National Academy of Sciences (NAS). The NAM is committed to upholding the independence, integrity, and scientific rigor of its work and work across the National Academies of Sciences, Engineering, and Medicine (NASEM). The NAM is working with the NASEM to ensure transparent communication about NASEM policies and procedures and to take timely action following the articles.
The following are answers to frequently asked questions in relation to the articles. This page will remain updated. Media inquiries: Bill Kearney (wkearney@nas.edu)
Has the NAM ever received funds from the Sacklers?
No. The NAM has never received funding from the Sacklers, nor does it have any relationship with any branch of the Sackler family. The donations described in the New York Times articles were made to the NAS, a separate academy from the NAM.
Were the funds donated to the NAS used to support work related to pain, opioids, or the opioid epidemic?
No. The funds were used by NAS to support the Raymond and Beverly Sackler Convergence Research Prize; the US-UK Scientific Forum; and the Arthur M. Sackler Colloquium series. Sackler funds provided partial support to the Human Genome Editing Initiative; Understanding and Responding to Global Health Security Risks from Microbial Threats in the Arctic; the Distinctive Voices lecture series; and the Kavli Frontiers of Science symposium program. These activities did not relate to the opioid crisis, and Sackler funds were never used to support a consensus study or other activity related to that topic.
What is the current status of the Sackler donations?
The NAS Council (its elected governing body) decided to freeze further use of the funds in 2019. Currently, the Council is actively assessing options to return or repurpose the funds. Legal limitations have added complexity to this process.
How does the NASEM shield against conflict of interest among members of consensus study committees?
The NASEM’s conflict-of-interest policy, updated in 2021, excludes from serving individuals who have a financial conflict of interest with respect to the issues to be addressed by the committee (unless the conflict is unavoidable). It also provides restrictions on the relationships individuals may have with the sponsoring entity to be eligible for service. The policy requires public disclosure of relevant relationships and information. Composition, balance, and conflict of interest are monitored and assessed throughout the course of the study. For more detailed information, please see the following overviews:
- Our Study Process
- Policy on Composition and Balance, Conflicts of Interest, and Independence for Committees Used in the Development of Findings, Conclusions, and Recommendations
What is the NASEM’s policy with regard to accepting funds from private sponsors?
The NASEM accepts private sponsorship from philanthropists, private foundations, corporations, and corporate foundations. The NASEM has strict conflict-of-interest procedures to ensure that such donations do not interfere with consensus study processes. Private sponsorship is accepted only when it is judged by NASEM governing bodies to uphold the NASEM’s independence, align with the NASEM’s mission and values, and avoid conflict of interest.
What are the NASEM’s (not the NAM’s) major reports on pain, opioids, and the opioid epidemic, and how were they funded?
The following is a non-exhaustive list of reports on these subjects. Visit nap.nationalacademies.org to access the NASEM’s complete catalog of publications. The full text of every publication is available to read online for free.
- Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research, released in 2011 by the Institute of Medicine, was a congressionally mandated report funded by the National Institutes of Health.
- Report summary (written at time of publication): Chronic pain costs the nation up to $635 billion each year in medical treatment and lost productivity. The 2010 Patient Protection and Affordable Care Act required the Department of Health and Human Services (HHS) to enlist the Institute of Medicine (IOM) in examining pain as a public health problem. In this report, the IOM offers a blueprint for action in transforming prevention, care, education, and research, with the goal of providing relief for people with pain in America. To reach the vast multitude of people with various types of pain, the nation must adopt a population-level prevention and management strategy. The IOM recommends that HHS develop a comprehensive plan with specific goals, actions, and timeframes. Better data are needed to help shape efforts, especially on the groups of people currently underdiagnosed and undertreated, and the IOM encourages federal and state agencies and private organizations to accelerate the collection of data on pain incidence, prevalence, and treatments. Because pain varies from patient to patient, healthcare providers should increasingly aim at tailoring pain care to each person’s experience, and self-management of pain should be promoted. In addition, because there are major gaps in knowledge about pain across health care and society alike, the IOM recommends that federal agencies and other stakeholders redesign education programs to bridge these gaps. Pain is a major driver for visits to physicians, a major reason for taking medications, a major cause of disability, and a key factor in quality of life and productivity. Given the burden of pain in human lives, dollars, and social consequences, relieving pain should be a national priority.
- Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use, released in 2017 by the NASEM, was sponsored by the Food and Drug Administration.
- Report summary (written at time of publication): Drug overdose, driven largely by overdose related to the use of opioids, is now the leading cause of unintentional injury death in the United States. The ongoing opioid crisis lies at the intersection of two public health challenges: reducing the burden of suffering from pain and containing the rising toll of the harms that can arise from the use of opioid medications. Chronic pain and opioid use disorder both represent complex human conditions affecting millions of Americans and causing untold disability and loss of function. In the context of the growing opioid problem, the U.S. Food and Drug Administration (FDA) launched an Opioids Action Plan in early 2016. As part of this plan, the FDA asked the National Academies of Sciences, Engineering, and Medicine to convene a committee to update the state of the science on pain research, care, and education and to identify actions the FDA and others can take to respond to the opioid epidemic, with a particular focus on informing FDA’s development of a formal method for incorporating individual and societal considerations into its risk-benefit framework for opioid approval and monitoring.
- Medications for Opioid Use Disorder Save Lives, released in 2019 by the NASEM, was sponsored by the Substance Abuse and Mental Health Services Administration and the National Institute on Drug Abuse of the National Institutes of Health.
- Report summary (written at time of publication): The opioid crisis in the United States has come about because of excessive use of these drugs for both legal and illicit purposes and unprecedented levels of consequent opioid use disorder (OUD). More than 2 million people in the United States are estimated to have OUD, which is caused by prolonged use of prescription opioids, heroin, or other illicit opioids. OUD is a life-threatening condition associated with a 20-fold greater risk of early death due to overdose, infectious diseases, trauma, and suicide. Mortality related to OUD continues to escalate as this public health crisis gathers momentum across the country, with opioid overdoses killing more than 47,000 people in 2017 in the United States. Efforts to date have made no real headway in stemming this crisis, in large part because tools that already exist—like evidence-based medications—are not being deployed to maximum impact.To support the dissemination of accurate patient-focused information about treatments for addiction, and to help provide scientific solutions to the current opioid crisis, this report studies the evidence base on medication assisted treatment (MAT) for OUD. It examines available evidence on the range of parameters and circumstances in which MAT can be effectively delivered and identifies additional research needed.
- Framing Opioid Prescribing Guidelines for Acute Pain: Developing the Evidence, released in 2020 by the NASEM, was sponsored by the Food and Drug Administration.
- Report summary (written at time of publication): The opioid overdose epidemic combined with the need to reduce the burden of acute pain poses a public health challenge. To address how evidence-based clinical practice guidelines for prescribing opioids for acute pain might help meet this challenge, Framing Opioid Prescribing Guidelines for Acute Pain: Developing the Evidence develops a framework to evaluate existing clinical practice guidelines for prescribing opioids for acute pain indications, recommends indications for which new evidence-based guidelines should be developed, and recommends a future research agenda to inform and enable specialty organizations to develop and disseminate evidence-based clinical practice guidelines for prescribing opioids to treat acute pain indications.The recommendations of this study will assist professional societies, health care organizations, and local, state, and national agencies to develop clinical practice guidelines for opioid prescribing for acute pain. Such a framework could inform the development of opioid prescribing guidelines and ensure systematic and standardized methods for evaluating evidence, translating knowledge, and formulating recommendations for practice.
What is the background of the 2011 Relieving Pain in America consensus study report?
This study was conducted by the Institute of Medicine (IOM), which was part of the National Academy of Sciences and under National Research Council (NRC) oversight. It was funded entirely by the National Institutes of Health (NIH) and initiated via a provision within the Affordable Care Act that recognized “pain as a significant public health problem in the United States.”
The NIH requested that the IOM conduct a study to assess the state of the science regarding pain research, care, and education and to make recommendations to advance the field. The NIH specifically requested that the study:
- Review and quantify the public health significance of pain;
- Identify barriers to pain care and strategies to reduce barriers;
- Identify populations that are undertreated or have special needs;
- Discuss tools available to advance pain management; and
- Discuss opportunities for partnerships in support of continuing research, care, & education.
To meet this charge, the IOM assembled a 19-member committee. All members of the committee were found to have no conflicts of interest according to IOM/NRC guidelines. The committee was diverse with regard to background and training, and included experts in pain research, clinical care, ethics, and consumer education, as well as patient advocates.
One frequently cited statistic from the study is the estimate that 100 million adults in the United States suffer from chronic pain conditions. That estimate was based on data from an original economic analysis performed specifically for the IOM by two health economists. This analysis used data from the 2008 Medical Expenditure Panel Survey (MEPS)—a nationally representative longitudinal survey co-sponsored by Agency for Healthcare Research & Quality and the National Center for Health Statistics that covers the U.S. adult, civilian, noninstitutionalized population.
The estimate was also consistent with a 2008 study from an international group of researchers, which was cited by the IOM study. This study suggested that the age-standardized prevalence of an adult experiencing any chronic pain condition in the previous 12 months was 43 percent in the United States, based on responses from the World Health Organization’s World Mental Health Survey, which was conducted in 17 countries across the globe.
What work is the NAM doing to address the opioid epidemic?
The NAM Action Collaborative on Countering the U.S. Opioid Epidemic, launched in July 2018, is a public-private partnership made up of participants representing federal, state, and local governments; health systems; associations and provider groups; health education and accrediting institutions; pharmacies; payers; industry; nonprofits; and academia. The Action Collaborative is committed to developing, curating, and disseminating multi-sector solutions designed to reduce opioid misuse and improve outcomes for individuals, families, and communities affected by the opioid crisis. The Action Collaborative’s function is to convene; it does not produce formal recommendations through consensus studies. The Action Collaborative does not have members representing the pharmaceutical industry and does not accept funds from any sponsor with a primary financial interest in developing, manufacturing, producing, distributing, or marketing any drug. The Action Collaborative is or has been sponsored by:
- Accreditation Council for Graduate Medical Education
- Aetna
- American Hospital Association
- American Medical Association
- American Society of Health-System Pharmacists
- Arnold Ventures
- Association of American Medical Colleges
- Centers for Disease Control and Prevention
- CDC Foundation
- Centers for Medicare & Medicaid Services
- Council of Medical Specialty Societies
- Federation of State Medical Boards
- HCA Healthcare
- National Association for Behavioral Healthcare
- National Institute on Drug Abuse
- The Pew Charitable Trusts
- Robert Wood Johnson Foundation
- Substance Abuse and Mental Health Services Administration
- Teladoc
- UnitedHealth Group
- U.S. Department of Veterans Affairs
