Medical schools evolve to prepare for opioid crisis, still ‘a long way to go’

Martin Klapheke
Martin Klapheke

The Commission on Combating Drug Addiction and the Opioid Crisis recently issued a recommendation to President Donald J. Trump to declare a national emergency to combat the growing opioid epidemic.

“Your declaration would empower your cabinet to take bold steps and would force Congress to focus on funding,” New Jersey Gov. Chris Christie and bipartisan committee members wrote. “It would also awaken every American to this simple fact: if this scourge has not found you or your family yet, without bold action by everyone, it soon will.”

The committee also recommended to expand guidelines the CDC released last year for primary care physicians prescribing opioids for chronic pain to now “mandate prescriber education initiatives with the assistance of medical and dental schools across the country to enhance prevention efforts.”

The Office of National Drug Control Policy estimates that — other than prescribers who are federally required to be trained — fewer than 20% of the more than 1 million prescribers licensed to prescribe controlled substances to patients have training on how to safely prescribe opioids.

“[Considering] the evolving opioid public health crisis, in 2016 the CDC released guidelines on prescribing opioids in primary care for chronic pain not related to cancer, palliative care or end-of-life care,” Martin M. Klapheke, MD, assistant dean for medical education at the University of Central Florida College of Medicine, told Healio.com. “Consequently, U.S. medical schools were called upon to strengthen their curricula on the appropriate use of opioids, with an emphasis on maximizing benefits while utilizing risk mitigation strategies to prevent addiction and overdose.”

Klapheke noted that the White House Office of Public Engagement collected a list of medical schools willing to require every student to complete training consistent with the CDC guidelines. The University of Central Florida College of Medicine was one of the more than 60 medical schools to take the pledge, he said.

Collaboration

“Following the lead of medical schools in Massachusetts and Pennsylvania, and supported by the Council of Florida Medical School Deans, nine medical schools in Florida [agreed to work] together to share training materials, tapping into each medical school’s expertise to collaborate in strengthening the education and training of medical students in pain management including, when appropriate, the safe use of opioids, and use, when indicated, of evidence-based treatments for addiction,” Klapheke said.

The best response is likely through the collaboration of city, state and federal systems, he said.

“The nine medical schools are working together through the Council of Florida Medical School Deans to outline shared core competencies in training,” he said.

Klapheke mentioned that in December 2016 the U.S. Department of Health and Human Resources hosted a group of physicians and medical educators at the White House to discuss strategies for collaboration in combatting the opioid public health crisis.

That same day, he added, the U.S. Senate passed the 21st Century Cures Act that included $1 billion for state grants to fight the opioid crisis.

“This is all a start, but we have a long way to go,” Klapheke said.

Paul George
Paul George
Credit: Scott Kingsley

Mutual responsibility

“With the large number of individuals using opioids inappropriately and the large number of opioid overdose deaths, responsibility lies with medical schools and residencies to train learners on when to prescribe opioids, how to appropriately dose opioids, how to stop opioids and, for those who are addicted, how to use medication-assisted treatment — like Suboxone (buprenorphine/naloxone, Indivior Inc.) — to treat opioid use disorders,” Paul George, MD, MHPE, assistant dean for medical education at the Warren Alpert Medical School of Brown University, told Healio.com.

However, George also noted that there is a responsibility for departments of health on the state level to ensure practicing physicians are adequately prepared to do the same “since the impact of training medical schools and residencies will not be felt for years — owing to the long pipeline of graduating attending physicians.”

Curriculum changes

“In Rhode Island and in Massachusetts, and quite honestly nationally, both the aggregate numbers of opioid overdose deaths and the personal stories of those dying from these overdoses have affected curriculum development at Brown,” George said. “Part of the reluctance to teach around opioid addiction was a lack of expertise amongst medical school faculty around pain management, [which] has changed in response to the large and increasing number of opioid overdose deaths.”

The Warren Alpert Medical School recently designed and implemented a curriculum in which students received 23 hours of study involving substance abuse, including opioid use disorders. Students are tested on their ability to screen, provide a brief intervention and refer treatment for individuals who are struggling with addiction, George said. Students are required to participate in the curriculum and testing to graduate, he said.

Additionally, the Warren Alpert Medical School teamed with the Rhode Island Department of Health to analyze its curriculum. The medical school then designed a program in which more than 30 members of the class of 2018 would receive the necessary training to prescribe FDA-approved medications for the treatment of opioid use disorders. The program, George said, is an effort to meet requirements of the Drug Abuse Treatment Act of 2000, which requires physicians to obtain a waiver to prescribe the medications.

Going through the training in medical school will allow students to apply for the waiver upon graduation.

The goal is to get “all of our students [to] graduate with the ability to prescribe medication-assisted treatment,” he said. “If all medical schools did this, the number of providers who can prescribe suboxone would increase exponentially.”

Klapheke said that the faculty at the University of Central Florida College of Medicine reviewed its coverage of opioids within its curriculum during the 4-year undergraduate medical education and added additional didactic and training experiences, including joint teaching by psychiatry and family medicine clerkship directors and faculty.

The college of medicine added a module on opioid risk mitigation strategies and overdose resuscitation to provide an interactive learning experience for third-year medical students, as informed by newest clinical guidelines from the CDC, the American Heart Association and the Substance Abuse and Mental Health Services Administration, Klapheke said. Further, the module focuses on how medical providers can educate patients and family or caregivers about recently FDA-approved formulations of naloxone — now available without a prescription in most states — to reverse acute opioid overdose and help save lives while emergency medical services are activated, he said.

“Naloxone may well become even more available in public areas than automatic external defibrillators,” Klapheke said. “Medical students need to know how to incorporate naloxone into resuscitation of patients in life-threatening opioid emergencies as well as how to be part of the education of their patients and families or caretakers on naloxone use.”

Regardless of what specialty medical students decide to go into, George said, they are going to be impacted by opioid misuse.

“It is not just the responsibility of primary care physicians and addiction specialists to have training in both responsible prescribing of opioids and treating opioid misuse,” he said. “If we are going to get this epidemic under control, it is going to take physicians of all specialties working together along with other health professionals like social workers and pharmacists to truly have an effect.” – by Ryan McDonald

Disclosures: George and Klapheke report no relevant financial disclosures.

 

Martin Klapheke
Martin Klapheke

The Commission on Combating Drug Addiction and the Opioid Crisis recently issued a recommendation to President Donald J. Trump to declare a national emergency to combat the growing opioid epidemic.

“Your declaration would empower your cabinet to take bold steps and would force Congress to focus on funding,” New Jersey Gov. Chris Christie and bipartisan committee members wrote. “It would also awaken every American to this simple fact: if this scourge has not found you or your family yet, without bold action by everyone, it soon will.”

The committee also recommended to expand guidelines the CDC released last year for primary care physicians prescribing opioids for chronic pain to now “mandate prescriber education initiatives with the assistance of medical and dental schools across the country to enhance prevention efforts.”

The Office of National Drug Control Policy estimates that — other than prescribers who are federally required to be trained — fewer than 20% of the more than 1 million prescribers licensed to prescribe controlled substances to patients have training on how to safely prescribe opioids.

“[Considering] the evolving opioid public health crisis, in 2016 the CDC released guidelines on prescribing opioids in primary care for chronic pain not related to cancer, palliative care or end-of-life care,” Martin M. Klapheke, MD, assistant dean for medical education at the University of Central Florida College of Medicine, told Healio.com. “Consequently, U.S. medical schools were called upon to strengthen their curricula on the appropriate use of opioids, with an emphasis on maximizing benefits while utilizing risk mitigation strategies to prevent addiction and overdose.”

Klapheke noted that the White House Office of Public Engagement collected a list of medical schools willing to require every student to complete training consistent with the CDC guidelines. The University of Central Florida College of Medicine was one of the more than 60 medical schools to take the pledge, he said.

Collaboration

“Following the lead of medical schools in Massachusetts and Pennsylvania, and supported by the Council of Florida Medical School Deans, nine medical schools in Florida [agreed to work] together to share training materials, tapping into each medical school’s expertise to collaborate in strengthening the education and training of medical students in pain management including, when appropriate, the safe use of opioids, and use, when indicated, of evidence-based treatments for addiction,” Klapheke said.

The best response is likely through the collaboration of city, state and federal systems, he said.

PAGE BREAK

“The nine medical schools are working together through the Council of Florida Medical School Deans to outline shared core competencies in training,” he said.

Klapheke mentioned that in December 2016 the U.S. Department of Health and Human Resources hosted a group of physicians and medical educators at the White House to discuss strategies for collaboration in combatting the opioid public health crisis.

That same day, he added, the U.S. Senate passed the 21st Century Cures Act that included $1 billion for state grants to fight the opioid crisis.

“This is all a start, but we have a long way to go,” Klapheke said.

Paul George
Paul George
Credit: Scott Kingsley

Mutual responsibility

“With the large number of individuals using opioids inappropriately and the large number of opioid overdose deaths, responsibility lies with medical schools and residencies to train learners on when to prescribe opioids, how to appropriately dose opioids, how to stop opioids and, for those who are addicted, how to use medication-assisted treatment — like Suboxone (buprenorphine/naloxone, Indivior Inc.) — to treat opioid use disorders,” Paul George, MD, MHPE, assistant dean for medical education at the Warren Alpert Medical School of Brown University, told Healio.com.

However, George also noted that there is a responsibility for departments of health on the state level to ensure practicing physicians are adequately prepared to do the same “since the impact of training medical schools and residencies will not be felt for years — owing to the long pipeline of graduating attending physicians.”

Curriculum changes

“In Rhode Island and in Massachusetts, and quite honestly nationally, both the aggregate numbers of opioid overdose deaths and the personal stories of those dying from these overdoses have affected curriculum development at Brown,” George said. “Part of the reluctance to teach around opioid addiction was a lack of expertise amongst medical school faculty around pain management, [which] has changed in response to the large and increasing number of opioid overdose deaths.”

The Warren Alpert Medical School recently designed and implemented a curriculum in which students received 23 hours of study involving substance abuse, including opioid use disorders. Students are tested on their ability to screen, provide a brief intervention and refer treatment for individuals who are struggling with addiction, George said. Students are required to participate in the curriculum and testing to graduate, he said.

Additionally, the Warren Alpert Medical School teamed with the Rhode Island Department of Health to analyze its curriculum. The medical school then designed a program in which more than 30 members of the class of 2018 would receive the necessary training to prescribe FDA-approved medications for the treatment of opioid use disorders. The program, George said, is an effort to meet requirements of the Drug Abuse Treatment Act of 2000, which requires physicians to obtain a waiver to prescribe the medications.

PAGE BREAK

Going through the training in medical school will allow students to apply for the waiver upon graduation.

The goal is to get “all of our students [to] graduate with the ability to prescribe medication-assisted treatment,” he said. “If all medical schools did this, the number of providers who can prescribe suboxone would increase exponentially.”

Klapheke said that the faculty at the University of Central Florida College of Medicine reviewed its coverage of opioids within its curriculum during the 4-year undergraduate medical education and added additional didactic and training experiences, including joint teaching by psychiatry and family medicine clerkship directors and faculty.

The college of medicine added a module on opioid risk mitigation strategies and overdose resuscitation to provide an interactive learning experience for third-year medical students, as informed by newest clinical guidelines from the CDC, the American Heart Association and the Substance Abuse and Mental Health Services Administration, Klapheke said. Further, the module focuses on how medical providers can educate patients and family or caregivers about recently FDA-approved formulations of naloxone — now available without a prescription in most states — to reverse acute opioid overdose and help save lives while emergency medical services are activated, he said.

“Naloxone may well become even more available in public areas than automatic external defibrillators,” Klapheke said. “Medical students need to know how to incorporate naloxone into resuscitation of patients in life-threatening opioid emergencies as well as how to be part of the education of their patients and families or caretakers on naloxone use.”

Regardless of what specialty medical students decide to go into, George said, they are going to be impacted by opioid misuse.

“It is not just the responsibility of primary care physicians and addiction specialists to have training in both responsible prescribing of opioids and treating opioid misuse,” he said. “If we are going to get this epidemic under control, it is going to take physicians of all specialties working together along with other health professionals like social workers and pharmacists to truly have an effect.” – by Ryan McDonald

Disclosures: George and Klapheke report no relevant financial disclosures.