Opioid Crisis Spurs Change at Medical Schools

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Medical schools are responding to the nationwide opioid epidemic by changing the way they train future doctors.

Over the past 15 years, many U.S. medical schools have begun offering lessons, courses and clinical rotations in drug addiction treatment and pain management, experts say, and some schools have added these topics to their required curriculum.

Faculty at schools that require all students to learn about addiction and pain say their goal is to ensure that graduates understand the differences between situations where an opioid prescription is an appropriate treatment for a pain condition and when it isn’t the best option.

Recent medical school graduates who received this training say it has helped them make decisions about whether to prescribe an opioid drug.

“I felt more comfortable and confident in myself, knowing not only when to say no but also when to say yes,” says Dr. Kevin O’Day, a 2016 graduate from the University of Massachusetts School of Medicine who is now an internal medicine resident at the university.

Regarding the lectures on addiction and pain he’s received as a student at the University of Pennsylvania’s Perelman School of Medicine, Nadir Bilici said via email, “It has been useful to understand the challenges that patients with drug addiction face beyond receiving clinical treatment; we have learned how various socio-politico-economic factors go into making and breaking communities of addiction.”

Experts say that it’s important for aspiring doctors to learn how to avoid either overprescribing or underprescribing opioid medications, since this comes up in most areas of medicine, including surgery and primary care.

“Nobody wants the patient to suffer because their pain was undermanaged,” says Dr. Karen Sibert, an anesthesiologist and associate clinical professor with the David Geffen School of Medicine at the University of California—Los Angeles.

Sibert says most medical schools have bolstered the amount of training they provide on opioid alternatives, including intravenous versions of non-narcotic pain medicines and medical procedures that numb portions of the body where pain is present.

 Experts say it’s critical for all aspiring doctors to learn how to safely manage the pain of patients who suffer from either chronic or acute pain. They say it’s also important for future physicians to understand that people with chronic pain often visit doctors without any obvious symptoms besides a declaration that they feel pain.

“They don’t look sick like someone with acute pain,” says Dr. Daniel Alford, professor of medicine at the Boston University School of Medicine. “When you have acute pain, your heart rate goes up, your blood pressure goes up, you look terrible, but with chronic pain, you can look like anyone else but you have this terrible chronic pain.”

Because there are not visible signs of chronic pain, Alford says, doctors are often skeptical of whether patients who claim to feel chronic pain are feeling pain at all.

Learning how to interview and counsel patients who express pain is a key skill to learn during medical school, experts say, and this can be cultivated through clinical simulations. Some of these simulations show students how to reject a request for an opioid prescription from someone who is misusing the drug.

 One key sign that a medical school provides solid training in pain and addiction medicine, according to experts, is if it offers the opportunity to listen to panels of patients who have suffered from either a pain condition or drug addiction. Another positive sign is if the school offers field trips to addiction treatment centers or addiction self-help group meetings, or if it has pain management specialists on its faculty.
Because of the prevalence of opioid misuse, experts emphasize that medical students need to learn how to recognize when a patient suffers from an opioid addiction, suppress opioid withdrawal symptoms and treat an opioid overdose. They say it’s not important whether a school’s lessons about pain and addiction medicine are taught in stand-alone courses as long as these topics are taught.

“I don’t really think you can look for a specific course,” says Dr. Melissa Fischer, associate dean for undergraduate medical education at the University of Massachusetts. “Just because somebody has a pain management course doesn’t mean they’re doing something better or differently than somebody that doesn’t have a course with that name.”

However, Fischer says it’s important to attend a medical school that addresses opioid addiction somewhere in its curriculum, because this kind of common addiction is a quickly progressing and frequently fatal.

“One of the issues with opioid misuse as a chronic disease is that most chronic diseases kill people slowly and silently, but opioid use disorder does not,” she says. “It kills people quickly and when they’re young.”

Dr. Mishka Terplan, associate director of addiction medicine and professor at the Virginia Commonwealth University School of Medicine, says the opioid crisis has led to vital reforms at medical schools. “The future of medicine is going to look very different in very good ways as a consequence of the tragedy that we’re living through,” he says.

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