How higher education is tackling the opioid crisis in America
Over 130 Americans die from drug overdoses every day, the result of the country’s lethal love affair with prescription painkillers and an insidious money-making scheme purportedly orchestrated by its manufacturers.
A big part of the problem is a lack of education and self-awareness about substance use disorders (SUDs) in the public sphere.
For one, it’s still not uncommon for drug addiction to be confused with drug dependence and vice-versa, a dangerous conflation of two problems typically triggered by different causes.
And when it comes to overdose deaths, all are treated as one and the same. This effectively removes public attention from the type of substances actually causing these fatalities: recreational drugs or the simple prescription painkiller found in nearly all American households.
Why Americans are addicted to opioids
The opioid crisis didn’t just start overnight–opiate addiction has been devastating communities in America for nearly three decades now, claiming tens of thousands of lives every year.
The problem can be traced to as far back as the 1990s, when pharmaceutical firms began assuring doctors their patients would not become addicted to pain relievers.
Today, big pharma would frame “opioid overuse” as a “drug abuse crisis”, shifting the blame to users, rather than those prescribing the highly addictive substances to unsuspecting Americans.
As such, many Americans still rely on a cocktail of drugs to get on with their days; up to seven in 10 are on prescription drugs, some popping up to five daily.
According to federal government data from the White House to National Institute on Drug Abuse (NIDA), nearly 30 percent of those prescribed opioids for chronic pain ended up misusing them.
Up to 12 percent would go on to develop an opioid use disorder, while 6 percent who misuse prescription opioids would graduate to heroin. Among the heroin users, 80 percent say they first misused prescription drugs.
In 2017, there were 72,000 drug overdose deaths. Of these, 49,000 involved opioids. That’s nearly 70 percent.
Overdose deaths fell 5 percent to 68,500 last year, with 47,600 related to opioids, a promising indicator that efforts to end the crisis are starting to pay off.
But observers have cautioned against early celebration, pointing to the continued rise of the synthetic opioid fentanyl, a chief cause of today’s fatalities.
Higher education to the rescue
Like any public health crisis, education and research are critical to stemming the tide of opioid abuse and SUDs.
This is where the nation’s colleges and universities come in. Home to some of the best and brightest minds in science and academia, not to mention the future generations of health professionals, institutions of higher learning are best placed to lead efforts in tackling the opioid crisis.
From where they stand at the nexus of education, research and clinical care, it becomes more than a professional obligation for them to so–it is a moral imperative and part of their civic responsibility.
Accordingly, many of the country’s best institutions have stepped up to the plate.
Across America, a comprehensive response to the opioid crisis has taken shape, with strategies involving enhanced medical education, improved patient care, research collaborations and partnerships with the public and private sectors.
To take a closer look at some of these efforts and how they contribute to the wider national agenda on the opioid crisis, we’ve compiled several case studies from across the medical education landscape, published by the Association of American Medical Colleges (AAMC) in a recent whitepaper.
This is not an exhaustive list and by no means describes the full extent of each institution’s work.
But they offer a clear and hopeful picture of how American higher education, working in cohesion with other state and non-state actors, are taking serious action to save the country from what has become the biggest drug epidemic in national history.
#1: Enhancing medical education
According to the 2016-2017 Annual Medical School Questionnaire by the Liaison Committee on Medical Education (LCME), the accrediting body for medical education programmes, “substance abuse” and “pain management” are topics covered in the majority of medical school curriculum, featuring in required or elective coursework.
LCME also found medical schools in America to be actively engaged in addressing the opioid crisis via the curriculum, covering topics on pain and SUDs in four key domains: the nature of pain; pain assessment and measurement, including assessment of risk for SUDs; management of pain, including SUD treatment and opioid overdose; and the context of pain and substance use disorder.
A telephone survey with curriculum deans or their equivalent at 147 LCME-accredited schools confirmed this, with 87 percent saying all four domains are addressed in their institution’s curriculum and 100 percent saying at least two of four are covered.
To ensure maximal exposure, institutions are putting in efforts to ensure the topics are reinforced at all stages of study.
For example, University of Central Florida College of Medicine expanded its opioid and pain-management curriculum to be used in all four years of medical school and graduate medical education.
The curriculum covers topics such as risk-management strategies and overdose reversal, team-based learning exercises on chronic pain therapeutics, and didactics on postoperative pain in various clerkships, in addition to training on the latest clinical guidelines.
Texas A&M Health Science Center, meanwhile, aims to train every health professions student on how to administer naloxone through its 90-minute Opioid Overdose Education and Naloxone Administration programme. According to AAMC, the school has more than 5,000 students in the health professions discipline.
To ensure the education sticks, Texas A&M evaluates the students’ knowledge and change in attitude, if any, about the opioid use disorder every 12 months.
At the NYU School of Medicine, students are made to take a week of pain-management instruction which involves didactics on the origin and impact of the opioid crisis, reforms taking place and the role of students in driving change across America.
They are also trained on dispensing naloxone, and participate in workshops on treating opioid use disorder and other SUDs, as well as other issues related to addiction.
The University of Massachusetts, Boston University, Harvard University and Tufts University have enhanced their curriculum with the inclusion of 10 core competencies covering SUD prevention, identification and treatment. At the University of Massachusetts, second-year medical students, graduating medical students, and graduating nursing students are required to participate in a simulation programme that trains them on how to treat and respond to patients and their families in different care settings.
Pain management and SUD content are also reinforced during residency training.
For example, fellows in addiction psychiatry and pain medicine at the Louisiana State University Health Sciences Center lead team-based programmes for medical students and help them with pain-management consultation services. The fellows are trained in a variety of clinical settings from outpatient clinics to intensive outpatient and residential treatment facilities, emergency departments, and hospital inpatient detoxification areas.
All primary care residents at the University of Buffalo’s Jacobs School of Medicine and Biomedical Sciences, whether in OB-GYN, psychiatry or emergency medicine are trained to detect SUDs and to use medical-assisted treatment (MAT) for opioid use disorder.
University of Louisville’s internal and family medicine residents participate in interactive workshops where they learn how to comunicate with patients about opioid medications.
Beaumont Health residents, meanwhile, participate in a year-long education programme that covers several aspects of the assessment and treatment of pain through lectures, experiential exercise and faculty-resident discussions.
#2 Improved patient care
Medical schools and teaching hospitals in America are working closely together with community organisations and other healthcare professionals on methods to tackled the opioid crisis through improved patient care.
“Physicians and residents, along with other health professionals at these institutions, are advancing comprehensive approaches that recognise pain management’s risks and benefits,” AAMC explains.
“These institutions are also implementing new methods and protocols to treat SUDs and addiction. Their goal is to achieve a balance that ensures patient access to pain medications when clinically appropriate while minimising the potential for misuse.”
The University of Colorado Hospital (UCH) has rolled out numerous efforts, some of which spread across the UCHealth system.
For example, UCH has expanded MAT across 24 counties in eastern and southern Colorado through the Implementing Technology and Medication Assisted Treatment Team Training in Rural Colorado (IT MATTTRs Colorado) programme. The school is working closely with local communities to enhance awareness of opioid use disorder and MAT, training more than 80 care teams on MAT services to date and helping over 400 care providers.
UCH has also partnered with University of Colorado School of Medicine to improve how UCH clinics manage chronic pain, an effort that has led to the standardisation of guidelines for screening, managing, and caring for patients.
Last year, the Medical University of South Carolina (MUSC) launched the state’s first Pain Rehabilitation Programme, a three-week, multidisciplinary intensive outpatient programme that lessens patients’ pain while transitioning to nonopioid pain treatments.
MUSC also has an Opioid Task Force, whose responsibilities include examining current prescription procedures across the system, identifing outliers and providing feedback to providers.
At all NYU Langone Health emergency departments, patients, as well as their family members, can receive naloxone kits and training on how to recognise overdoses and how to administer naloxone.
#3 Research collaborations
According to AAMC, scientists at medical schools and teaching hospitals in America are responsible for at least half the research supported by the National Institutes of Health (NIH) on pain and substance use, to improve understanding of pain management and addiction and develop new and more effective treatments to end the opioid crisis.
The results of their research not only unlock new discoveries on better methods for pain management to fix gaps in care delivery, they also benefit the education and training of the country’s future health professionals.
At Stanford University School of Medicine, researchers are working on developing a pain-relieving compound unrelated to opioids that will no lead to addiction or interfere with breathing.
NYU Langone Health’s interdisciplinary investigators, meanwhile, have partnered with local health departments to study the drivers of the opioid academic and provide evidence on the most effective prevention measures and treatments in various clinical settings.
A collaborative effort by researchers at the University of Minnesota Medical School and Minneapolis Medical Research Foundation at Hennepin Healthcare seeks to develop vaccines against heroin and prescription opioids that use the immune system to produce antibodies that target, bind to, and prevent the opioids from reaching the brain.
A team at the University of Massachusetts Medical School has studied the use of wearable technology to measure temperature, heartbeat, motion, and skin electrical conductance to track patients in recovery. This is to identify when patients experience a relapse and can be used to get in touch with a sponsor or physician in such an occasion.
#4 Partnerships with public and private sectors
A problem like the opioid crisis in America is one massive scale and magnitude and cannot be fought alone. Efforts by learning institutions across America must be supplemented by the financial firepower and political will of the public and private sectors.
Earlier this month, the government through the Department of Health and Human Services (HHS) announced more than US$1.8 billion in funding to states to support initiatives to combat the opioid crisis. The funds will go towards advancing efforts to expanding access to treatment and supporting near real-time data on drug overdoses.
This is part of a broader initiative by the Trump administration to combat the crisis. After declaring a public health emergency in 2017, the government last year rolled out the Initiative to Stop Opioid Abuse, an ongoing three-pronged, all-of-government approach covering a broad range of actions to confront its driving forces.
In addition to cracking down on international and domestic drug supply chains, the strategy involves reducing drug demand and overprescription through education, awareness and prevention efforts, and providing evidence-based treatment and recovery support services to treat struggling addicts.
AAMC-member institutions have also teamed up with local public health and community organisations on numerous programmes and initiatives to both identify, prevent and treat opioid use disorders and SUDs.
New York Medical College has partnered with the Westchester County Department of Health to teach medical students what to consider before prescribing an opioid for pain control.
A recent partnership between the Unversity of Waterloo School of Pharmacy and the Addiction Policy Forum saw the release of a comprehensive Overdose Awareness Toolkit that teaches the public, through training videos, how to recognise and respond to an overdose, as well as provides information on how to administer naloxone, among others.
Faculty from the Jacobs School in New York, meanwhile, are core members of an Erie County Opioid Task Force, which has created guidelines for managing acute pain approved by the county medical society and representatives from specialty societies.
In combination with CDC guidelines, these efforts have resulted in a marked reduction in opioid prescriptions in the region, according to the AAMC. Between 2016 and 2017, opioid-related deaths in Erie County reportedly dipped by 17 percent.
Emergency medicine faculty at University of Buffalo’s Jacobs School of Medicine and Biomedical Sciences have also provided training for hundreds of police, first responders, and members of the public in naloxone rescue, in efforts to increase the number of certified naloxone administrators.