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Second Opinion

Learn about policy issues important to medical schools and teaching hospitals, with Executive Vice President Atul Grover, M.D., Ph.D.

Today’s Opioid Epidemic in the Context of 20 Years of Medical Education Experience

January 27, 2016

The growing opioid abuse epidemic has been on health care’s radar screen for years. For example, research into the issue in 2012 External Link found:

  • 5.1 million American illicit-drug users used pain relievers.

  • Opioid analgesics caused more deaths than both suicide and motor vehicle crashes.

  • 40 percent of opioid-related deaths occurred from abusing drugs obtained through multiple prescriptions, doctor shopping, and drug diversion.

These are the hallmarks of an epidemic. On the campaign trail, congressional and presidential candidates of both parties have talked to voters about other issues, but time and again families and local officials haven’t let them get away without discussing opioid abuse and its terrible consequences. The toll this public health crisis has taken on families and communities nationwide has made it a major issue for both Congress and the White House.

In a Capitol Hill briefing this week, representatives from the nation’s medical schools and teaching hospitals will discuss the development of their unique approaches to opioids, demonstrating the benefits of not only drawing on national experience and resources but also developing new models of training and education that are driven by the community’s needs.

When I think about this epidemic, it takes me back to my residency at San Francisco General Hospital in the 1990s and another public health crisis. One of the nation’s largest public hospitals, San Francisco General was at the forefront of the HIV crisis.

There are strong similarities between today’s opioid epidemic and the HIV epidemic back then. According to the Centers for Disease Control and Prevention, the rate of deaths related to drug use in 2014 External Link was comparable to the HIV death rate at its peak in 1995. Deaths due to drug use have exploded in recent years, largely because of opioid abuse.

Initially, both epidemics were viewed as problems primarily of marginalized populations. It took too long to recognize that HIV was a serious public health threat, but academic medical centers (AMCs) were pivotal in driving research and clinical care forward. Twenty years later, AMCs are applying their expertise in research, education, and clinical care to address the threat posed by opioids.

I think about opioid abuse particularly in terms of how medical education has changed over the past two decades. Pain management was an essential part of my education, a component of every clinical rotation in medical school and during my residency. The same was true for substance abuse—it was impossible to train in an inner-city hospital and not be confronted by affected patients.

Over time, the pendulum has swung in medicine’s thinking about how to relieve a patient’s pain. At first, medical professionals believed the risk of overmedication was too great, and then they thought patients were inadequately medicated for pain and should have more control over their pain management. Today, physicians are working to advance comprehensive approaches that recognize pain management’s risks and benefits. Achieving the right balance is a continuing goal to ensure that patients have access to pain medications when clinically appropriate but are not misusing them.

Medicine—and therefore medical education—is constantly evolving in response to the latest science and communities’ greatest needs. As a consequence, AMCs have a leadership responsibility not only to provide care specifically for those suffering from opioid addiction but also to advance the science of the condition and to train health professionals in the prevention, diagnosis, and treatment of opioid abuse.

I see such AMCs stepping up in community after community, developing and implementing new treatment models and curricula based on the latest understanding of the epidemic in their localities, states, and regions. In this week’s Capitol Hill briefing, the Indiana University School of Medicine, the Geisel School of Medicine at Dartmouth in New Hampshire, and Massachusetts’s four medical schools External Link will share their unique approaches to dealing with the issue of opioids in their communities.

We cannot afford to write off opioid abuse as a local problem that affects “other people.” The nation’s medical schools and teaching hospitals understand this and are proud to continue to take on this important issue.

For more information on the briefing, contact Clay Crabtree at ccrabtree@aamc.org.

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About the Author

Atul Grover, MD, PhD AAMC Executive Vice President

Atul Grover, MD, PhD
AAMC Executive Vice President

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@AtulGroverMD



For More Information

Peters Willson
Sr. Specialist, Policy and Constituency Issues
Telephone: 202-862-6029
Email: pwillson@aamc.org