Can a Novel Med School Curriculum Curb the US Opioid Epidemic?

An opioid-centered curriculum for medical students improves awareness of pain management and treatment of opioid use disorder (OUD) and may help mitigate the current opioid crisis in the US, new research suggests.

"Our study showed that implementing training for medical students about opioid use disorder and its treatment improves knowledge and understanding of clinical principles and may better prepare students to treat patients with this disorder," study investigator Kimberly Hu, MD, psychiatry resident, Ohio State University, Columbus, told Medscape Medical News.

The findings were presented at the American Psychiatric Association (APA) 2022 Annual Meeting.

The US opioid epidemic claims thousands of lives every year and there's evidence it's getting worse, said Hu. US Data from December 2020–December 2021 show opioid-related deaths increased by almost 15%.

In 2019, about 70% of the nearly 71,000 drug overdose deaths in the US involved opioids and now it exceeds 100,000 per year, said Hu. She noted 80% of heroin users report their addiction started with prescription opioids, data that she described as "pretty staggering."

Although treatments such as buprenorphine are available for OUD, "insufficient access to medications for opioid use disorder remains a significant barrier for patients," said Hu.

"Training the next generation of physicians across all specialties is one way that we can work to improve access to care and improve the health and well-being of our patients."

The study, which is ongoing, included 405 third-year medical students at Ohio State. Researchers provided these students with in-person or virtual (during the pandemic) training in buprenorphine prescribing and in-person clinical experience.

Hu and her colleagues tested the students before and after the intervention and estimated improvement in knowledge (score 0 to 23) and approach to clinical management principles (1 to 5).

The investigators found a statistically significant increase in overall knowledge (from a mean total score of 18.34 to 19.32; P < .001). There was also a statistically significant increase in self-reported understanding of clinical management principles related to screening for and treating OUDs (from a mean of 3.12 to a mean of 4.02; P < .001).

An additional evaluation survey was completed by 162 students at the end of the program. About 83% of these students said they knew how to manage acute pain, 62% felt they knew how to manage chronic pain, and 77% agreed they knew how to screen a patient for OUD.

Hu noted third-year medical students are a little over halfway through medical school, after which they will go into residency in various specialties. Providing them with this knowledge early on allows them to incorporate it as they continue their training, she said.

"If they are able to screen their patients in any specialty they eventually choose to go into, then they can help link these patients to resources early and make sure there aren't patients who are slipping through the cracks."

Worthwhile, Important Research

Howard Liu, MD, chair of the University of Nebraska Medical Center Department of Psychiatry and incoming chair of the APA's Council on Communications, applauded the study.

The proposed curriculum, he said, instills confidence in students and teaches important lessons they can apply no matter what field they choose.

Liu, who moderated a press briefing highlighting the study, noted every state is affected differently by the opioid epidemic but the shortage of appropriate treatments for OUD is nationwide.

Commenting for Medscape Medical News, addiction specialist Elie G. Aoun, MD, assistant professor of clinical psychiatry at Columbia University College of Physicians and Surgeons - Division of Law, Medicine, and Psychiatry, said this research is "very worthwhile and important."

He noted that attitudes about addiction need to change. When he taught medical students about substance use disorders, he was struck by some of their negative beliefs about addiction. For example, considering addicts as "junkies" who are "taking resources away" from what they perceive as more deserving patients.

Addiction has been ignored in medicine for too long, added Aoun. He noted the requirement for addiction training for psychiatry residents is 2 months while they spend 4 months learning internal medicine. "That makes no sense," he said.

"And now with the opioid epidemic, we're faced with the consequences of dismissing addiction for such a long time."

A lack of understanding about addiction, and the "very limited number" of experienced people treating addictions, has contributed to the "huge problem" experts now face in treating addictions, said Aoun.

"So you want to approach this problem from as many different angles as you can."

He praised the study for presenting "a framework to 'medicalize' the addiction model" for students. This, he said, will help them build empathy and see those with a substance use disorder as no different from other patients with medical conditions.

A curriculum such as the one presented by Hu and colleagues may spur more medical students into the addiction field, he said. "It may make them more willing to treat patients with addiction using evidence-based medicine rather than dismissing them."

The study was supported by the Substance Abuse and Mental Health Services Administration.

American Psychiatric Association (APA) 2022 Annual Meeting. Abstract 5485. Presented May 23, 2022.

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