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Medical Schools Engage Communities and Stakeholders in Response to Opioid Epidemic

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June 22, 2016

On June 8 at the AAMC Government Relations Representatives (GRR) meeting, a panel of representatives from three medical schools described the extent of the opioid epidemic in their areas and how their institutions are responding to the opioid and substance abuse crisis in their communities by enhancing existing education, training, research, and care programs.

 “In terms of the emergence of a public health crisis, in 2013 there were 6,315 incidents—ambulance calls, ER visits, and the like, directly linked to opioid overdoses. Two years later, we were up to almost 12,000 incidents. Going from the year 2000 with 338 opioid-related deaths across the state to 2015 with almost 1,526. You can see that dramatic increase,” Jim Leary, JD, vice chancellor for community and government relations at the University of Massachusetts Medical School (UMMS), said as he described the depth of the issue in Massachusetts.

“State policies helped to dry up some pain pill use. Heroin became very cheap to get, and now we have a major heroin problem,” said Gary Murdock, vice president of health policy and governmental affairs at West Virginia University (WVU) Medicine, about addiction in his state.

In response, each institution expanded its existing substance abuse and pain management curricula and research, as well as its clinical care.

To deliver care to those dealing with substance abuse issues, the University of Cincinnati used provisions recently passed in the Ohio state budget to expand its needle exchange program outside city limits to neighboring counties and rural areas, explained Mike Carroll, assistant vice president for governmental relations at the university. Judith Feinberg, MD, a University of Cincinnati College of Medicine faculty member started the program with grant funds from a local foundation and a donated van External Link by faculty member Judith Feinberg, MD, after she noticed an increased incidence of endocarditis, a heart infection that can be spread by sharing needles to inject heroin.

“Without that change in state law, it was really just limited to the city. We had no authority to go anywhere else,” Carroll said. Making use of the provisions, the Cincinnati Exchange Project (CEP) now has four sites and will expand to five this fall. In addition to exchanging needles, the sites screen for HIV, hepatitis C, and syphilis and refer clients to addiction treatment providers. The program also received a two-year grant from the Ohio Department of Health in 2014 to provide nasal naloxone, an emergency treatment for overdoses or possible overdoses.

Approximately 10 percent of those referred to treatment by CEP sites complete it. “We are not just exchanging needles. We are helping individuals who want to transform their lives, to transform them,” Carroll said.

Murdock discussed WVU School of Medicine’s work in patient care, partnerships, training and education, and research . “In terms of reforming patient care, we are talking about comprehensive opioid addiction treatment. We are the largest provider of treatment in the state,” he said.

WVU offers first- and second-year medical students courses that specifically address how to identify the risk of addiction and refer patients for treatment. More in-depth addiction training is offered for residents, and fellows receive psychiatry education with an emphasis on substance abuse treatment.

The medical school partners with the WVU School of Pharmacy to educate middle and high school students about the dangers of substance abuse. Its other partnerships include one with law enforcement agencies to distribute naloxone to first responders. Through the West Virginia Practice-Based Research Network, researchers work with primary care physicians, nurses, and other health professionals to translate research findings into implementation of substance abuse prevention and treatment programs in community settings. WVU and Marshall University each pledged $750,000 for collaborative programs that research solutions for health issues in West Virginia.

Along with the other Massachusetts medical schools, UMMS worked with the governor and other stakeholders to devise core competencies PDF External Link for medical education in prescription drug misuse. The core competencies break down into three domains—prevention of prescription drug misuse, treatment of patients at risk for substance use disorder, and management of substance use disorder.

“Each of the schools had a number of different members, and they were top members—leadership, members of the faculty, members of the school administration. They spent from June 2015 to November 2015 looking at medical education, looking at what the needs are, and they identified 10 core competencies that every prescriber ought to know and put that into a formal agreement. The schools all agreed that we are, in some fashion, going to implement this,” Leary explained.

Leary went on to discuss how UMMS implemented the core competencies through its mandatory Opioid and Safe Prescribing Training Immersion ( OSTI External Link) program for second-year medical students, graduating medical students and graduating nursing students. The OSTI program involves interactions with simulated patients in a variety of care settings, after which students receive feedback on their work. Students also engage with actual patients in recovery and their families via panel discussions. Panel members vary and have included a state legislator who also serves as a substance abuse counselor and a mother whose child was battling heroin addiction. Hands-on care instruction, including how to use Narcan (naloxone), is also provided.

A mandatory reflective writing component allows students to think personally about substance abuse and treatment. “The faculty who are teaching these courses say virtually every one of [the students] has a story. Your cousin, or a sibling, or your friend growing up. So they are able to relate to it that way and bring that to their medical training,” Leary said.

Tannaz Rasouli
Sr. Director, Public Policy & Strategic Outreach
Telephone: 202-828-0525

Susan Beach
Senior Director, Strategic Communications
Telephone: 202-828-0983

Presentation Materials

James Leary, JD; Gary Murdock; D. Michael Carroll - Presentation 

Related Resources

Going Above and Beyond for a Healthier West Virginia 

AAMC Key Issues: Responding to the Opioid Epidemic Through Education, Patient Care, and Research—AAMCNews