How Medical Schools Are Changing Their Approach to Opioid Education

By: Taylor Davis

The opioid epidemic is one of the hottest topics in the healthcare industry today. With more than two million Americans addicted to prescription painkillers and more than 90 dying from opioid overdoses each day, healthcare organizations of all types are asking, What can we do to treat this addiction and prevent this epidemic?¹

In general, it’s been assumed that, if a doctor prescribes a painkiller, it poses little risk to the patient’s long-term health. Because of this, medical schools and pharmacy schools have not emphasized opioid addiction prevention. They have taught the pharmacological aspects of medications but have not focused on the psychosocial or economic factors that contribute to addiction.² Students have not been trained to determine when a patient is prone to opioid addiction — or already addicted — or to offer painkiller alternatives.

That’s all changing.

Making a Switch

As a response to the rising opioid addiction crisis, the White House asked medical schools to expand their curricula in March 2016 based on opioid prescribing guidelines from the Centers for Disease Control and Prevention (CDC).³ These guidelines include three focus areas:

1. Determining when to initiate or continue opioids for chronic pain
2. Opioid selection, dosage, duration, follow-up and discontinuation
3. Assessing risk and addressing harms of opioid use⁴

With these guidelines in place, medical schools have been forced to make addiction prevention a priority when prescribing opioids. Their students are now taught to consider the long-term effects of opioid prescriptions, as well the potential benefits of alternative treatment methods for pain relief. In addition, when opioids are the best option, clinicians must be more thorough in deciding the length of time patients take the medication and the dosages they prescribe.

What the Med Schools Have to Say

Following the White House request, the Association of American Medical Colleges and the American Association of Colleges of Pharmacy issued a statement emphasizing the schools’ commitment to providing opioid-related education and training. This includes various methods, such as:

• Prescription drug monitoring programs to monitor controlled substance use
• Urine toxicology screens
• Medication-assisted therapies such as buprenorphine or methadone
• Assessments for prescribing naloxone, which reverses opioid overdose²

Many medical schools and pharmacy schools have expressed support of the White House commission and the associations’ response. In particular, Darren Freeman, DO, Director of Pain Management at the University of California Riverside School of Medicine, stated:

“All providers who prescribe opioids must be registered with the Controlled Substance Utilization Review and Evaluation System (CURES) and must check this database of controlled substances quarterly for any potential overdoses as well as administer urine toxicology screening twice annually.”³

This added checkpoint provides valuable patient data to guide physicians’ decision-making processes and holds them accountable to the safer practice of prescribing opioids.

A Focus on Long-Term Impact

While there are many factors contributing to the opioid epidemic and many proposed solutions from all sides, medical school training has shown to play a role. Based on a recent Princeton University study of opioid prescription rates, researchers estimated there would have been 56 percent fewer opioid prescriptions and nine percent fewer deaths from opioid overdoses if all general practitioners prescribed opioids at the same rate as those who graduated from Harvard, the top-ranked medical school.⁴ The level and quality of training a physician receives can have a significant impact on the way he or she approaches opioid prescriptions.

By implementing training programs and curricula designed to equip students to prescribe opioids more safely, medical and pharmacy schools can take steps to stop opioid addiction before it’s even a possibility for patients. Not only should these schools be focused on providing students with the right tools and information, but also with bringing the opioid epidemic to the forefronts of their minds. If students are aware of the prevalence of opioid addiction and the dangers these drugs pose to their future patients, they are more likely to take precautions when they are faced with these prescribing decisions. The changes schools are making right now have great potential to influence the way the medical community views opioid prescription, addiction and recovery for many years to come.

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Sources:

¹ “Doctors trained at lower-ranked American medical schools prescribe more opioids.” The Economist, August 23, 2017.

¹ Appold, Karen. “How medical schools are responding to the opioid epidemic.” Managed Healthcare Executive, August 12, 2017.

¹ Karon, Amy. “Medical schools respond to the opioid epidemic.” ACP Internist, January 2017.

¹ “CDC Guideline for Prescribing Opioids for Chronic Pain.” Centers for Disease Control and Prevention, Accessed October 15, 2017.