Second-year medical student Kate Otto, MPA, carries a medication in her purse that can save someone’s life.
Naloxone is a drug that can be administered by trained responders and lay people to reverse the often-fatal effects of an opioid overdose. Otto, who attends NYU School of Medicine, learned how to use naloxone as a member of NYU’s student-run Harm Reduction Club, which also provides naloxone training to at-risk community members, such as residents at a local men’s shelter. The naloxone training complements the opioid-related education she receives in the classroom and during her clinical rotations at Bellevue Hospital Center, where, Otto said, “As long as you’re keeping your eyes open, you’ll see [substance abuse problems] all around you.”
According to the Centers for Disease Control and Prevention (CDC), the number of opioid-related overdose deaths has increased fourfold since 1999, with more than 28,000 people dying from opioid-related overdoses in 2014 alone. In response, medical schools nationwide are enhancing and strengthening their curricula to give students the tools they need to confront the opioid epidemic while caring for patients in acute and chronic pain.
As a future primary care physician, Otto said she not only wants to help curb the nation’s opioid abuse and overdose epidemic, but learn how to help patients avoid addiction in the first place.
“We have to be aware of how to respond and treat [opioid abuse] but also how to be involved in a patient’s life to prevent that from happening,” she said.
In March 2016, the AAMC issued a statement highlighting schools’ and teaching hospitals’ ongoing commitment to opioid-related education and training. So far, 74 medical schools have signed on to the statement; many institutions also signed on to a White House pledge to incorporate CDC guidelines into the curriculum.
Among the schools enhancing their opioid-related curricula is the University of Massachusetts Medical School (UMass). Sean Maloney, MD, a recent UMass graduate, the school’s intensive training in pain management and opioid prescribing will help him live up to the oath to first do no harm.
“It needs to be a high priority because first and foremost, we’re supposed to do no harm,” he said. “Without the foundation I’ve been given through UMass, it wouldn’t even be in the forefront of my mind, which it really needs to be.”
UMass is among the four Massachusetts medical schools—along with Tufts University School of Medicine, Harvard Medical School, and Boston University School of Medicine—that in 2015 committed to using a new set of 10 core competencies to shape opioid education.
At Tufts, new elements were added to an existing pain management curriculum, according to Scott Epstein, MD, the school’s dean for educational affairs. Students previously took a course in addiction medicine that covered neurological effects of opioids and other drugs and taught how to screen patients for substance abuse risk. Toward the end of their first year and throughout their second year, students apply their newly acquired knowledge in a primary care setting, where they screen real patients for substance abuse risk.
In the enhanced curriculum, the Medical Interviewing and Doctor-Patient Relationship course includes pain assessment and related standardized patient scenarios. During their clerkships, Tufts students also are observed on their ability to assess pain and substance abuse risk and their use of Massachusetts’s Prescription Monitoring Program, which allows physicians to view a patient’s prescription drug history in an effort to prevent doctor shopping and drug diversion.
“We’ve coupled this with efforts to improve student education around pain management,” Epstein said. “Pain is ubiquitous. It really is a chronic disease, so if we take that viewpoint, it makes it easier to see how important this is.”
At the University of Central Florida (UCF) College of Medicine, enhancing the curriculum to better address opioid abuse was a “no-brainer,” said Martin Klapheke, MD, assistant dean for medical education and professor of psychiatry. While students already learned about pain neurology, opioid prescribing, addiction risk, and nonopioid therapies, Klapheke said that the “degree of this public health crisis” has pushed the college to do more.
“We didn’t have to debate this one,” said Klapheke, referring to the difficulties of fitting new lessons into an already packed curriculum. “When you realize that the majority of people using heroin began with prescription opioids, it’s a slap in the face and a wake-up call.”
In response, Klapheke and colleagues are enhancing both preclinical and clinical education on pain management, addiction risk mitigation, the use of prescription drug monitoring systems, naloxone training, and the CDC’s new voluntary guidelines for opioid prescribing, among other issues. Klapheke noted that of particular importance, students are taught to fully engage patients and their families in discussing the risks and benefits of different pain therapies.
“It is fairly astounding how easily we have prescribed opioids over the last 20 years with inadequate attention to the harms. So it’s nice to see the new attention [on the issue] leading to some real changes.”
Josh Lee, MD, MSc
Back at NYU, Vicky Harnik, PhD, associate dean for curriculum, said the school has always offered a “rigorous” curriculum on chronic pain and addiction. All NYU medical students receive a full week of pain management education within their first 18 months. However, with the opioid crisis in mind, the school is adding some new components. For example, students transitioning into residency now take part in pain assessment and management training that deals directly with opioids. In addition, the school’s curriculum will soon include a lecture about nonpharmacological pain treatment.
Beyond educating future physicians, Harnik noted that medical schools are on the front lines of opioid-related scientific research. Josh Lee, MD, MSc, an associate professor in NYU’s Department of Population Health, studies and leads clinical trials on the efficacy of opioid addiction treatments such as naltrexone. Noting that these addiction therapies are often prescribed in primary care settings, Lee said such research is becoming more relevant for medical students and residents, particularly for those who might eventually practice in communities without mental health and addiction services.
“It is fairly astounding how easily we have prescribed opioids over the last 20 years with inadequate attention to the harms,” Lee said. “So it’s nice to see the new attention [on the issue] leading to some real changes.”