A Focus on Opioid Education Efforts
Over the last several years, we’ve spent a significant amount of time looking at opioid epidemic response plans and have tried to figure out what has worked and what hasn’t. One common theme throughout many of the state and federal level action plans is a call for “more provider education” with the central idea that inappropriate opioid prescribing rates can be decreased through better awareness and information. Indeed, there is some evidence to support this approach—according to the CDC, high opioid prescribing counties have prescription rates that are greater than six times what they are in the lowest prescribing ones., This suggests “a lack of consistency in prescribing habits—and in provider education and protocols.2”
With that variability in mind, we thought it would be worthwhile to highlight some of the work going on to address this critical issue. At AffirmHealth, we don’t personally endorse any of these particular organizations over others, but we applaud and support all of their efforts.
Opioid Teaching Comes to Graduate Medical Education
One of the most active organizations has been the American Association of Medical Colleges who note that “medical educators are enhancing existing coursework in pain management and substance abuse in innovative ways. While students are exposed to this material through multiple modalities in medical school, to be maximally effective, such experiences are being reinforced throughout the continuum of medical education including in residency training, clinical experiences, and continuing education for practicing physicians.”
To operationalize this concept, the AAMC is supporting a number of activities:
- AAMC National Workshop to Advance Medical Education to Combat Opioid Misuse: Working Together Across the Continuum
In collaboration with the ACGME, and with funding support from the CDC, AAMC is hosting a national workshop in May 2019 that will bring together teams from medical schools and teaching hospitals to create and advance educational content around pain management and addiction for incorporation into medical curricula.
- Curricular Innovation Awards
In October 2018, AAMC recognized four medical education programs that provided “innovative pain, substance use and addiction training, including non-pharmacologic approaches to patient care.3” Programs recognized included University of Massachusetts Medical School, University of Michigan Medical School, Uniformed Services University of the Health Sciences, and Warren Alpert School of Medicine at Brown University.”
- Challenge Grants
In the near future, AAMC will announce a call for challenge grant applications supported, in part, by the Samueli Foundation. These grants will be made to institutions seeking to create and deploy resources in collaboration with other innovators across the medical education continuum.
Throughout 2017, AAMC hosted a series of webinars targeting undergraduate, graduate, and continuing medical education audiences that focused on different aspects of the opioid epidemic. These webinars remain available for public viewing on the AAMC website.
Opioid Teaching for the Established Clinician
The American Medical Association points out that since 2017, nearly 550,000 physicians and other health care professionals across the United States have completed CME training hosted by AMA and partner organizations focused around the opioid epidemic. Indeed, at least two hours of CME training on the epidemic has become a requirement for medical licensure in most states. On their website, the AMA hosts a variety of links to state, federal, and nonprofit entities that have released educational guidelines and resources.
The New England Journal of Medicine Catalyst also does a good job of delineating five specific areas for improved provider education2:
- “Screening patients
- Prescribing appropriately, including using prescription drug monitoring programs (PDMPs)
- Communicating with patients about pain management alternatives
- The effectiveness of naloxone and substance use treatment options, including medication-assisted treatments (MAT)
- Understanding and addressing bias and stigma.”
On the topic of screening patients, it remains clear that clinician recognition of opioid abuse among our patients must remain an area of continued focus and diligence. The Catalyst article does a good job of highlighting the Substance Abuse and Mental Health Services (SAMHSA) guide and the National Institute on Drug Abuse (NIDA) Drug Screening Tools, both of which can be used to educate providers about recognizing abuse behaviors in our patients.
The article also does an excellent job linking to a variety of resources on prescribing appropriately which is also a topic we’ve written about extensively. And finally, the paper makes the key point that expanding access to naloxone and improving access to treatment are key targets for education interventions. Each of these five areas are core topics that can be addressed with targeted CME across the provider continuum.
Takes Time To Solve Opioid Epidemic Puzzle
We’ve frequently written that alleviating the opioid epidemic in our country has no single solution. Similarly, improved education will not be enough to address this multifactorial problem. But, it is clear that many are doing excellent work to help inform and improve clinician recognition of opioid abuse, manage inappropriate prescribing, and help transition patients into treatment when they are identified.
We believe these efforts will take time to ultimately yield their benefits, but it is clear that they are critical pieces in helping to solve the opioid epidemic puzzle.