Med-school lesson plans adapt to opioid epidemic

About 80 percent of people who use heroin started with opioid pain medicine, whether it was obtained legally or illegally, according to Dr. Michael Ashburn, director of the Penn Pain Medicine Center at Philadelphia-based Penn Medicine.

Ashburn and other medical school leaders around the state are examining how physicians are trained to prescribe opioid pain pills in an effort to improve it and to reduce addiction risks. Overdoses on opioid pain pills and heroin account for about 10 deaths per day in the commonwealth.

State regulators are set to release before the end of the year the curriculum developed by the medical school leaders to improve opioid pain pill education in Pennsylvania

The curriculum revisions follow recent legislation requiring medical schools to update lessons related to pain management, alternatives to opioid pain medications, safe prescription methods and identification of patients at risk of addiction.

The legislation is one of several laws that Gov. Wolf signed this fall to combat the opioid pain pill and heroin epidemic.

Other legislation signed in November limits minors to seven-day prescriptions of opioid pain pills, limits the amount of opioids handed out in emergency departments, requires physicians and pharmacists to track more quickly opioid prescriptions, and increases the number of drop boxes around the state for residents to dispose of unused medicine.

Revamping how and what medical students are taught is just one step in a complex journey to recovery for the state, which lost more than 3,500 lives to drug-related causes in 2015.

The state’s intention is that by teaching physicians not to over-prescribe or mishandle opioids for pain management, less people will get hooked on pain medicine and turn to heroin use.

“In a nutshell, there has been several studies on opioid curriculum across the country, and we recognize that we could do better,” Ashburn said. “It’s not that we’re doing nothing, but we recognize that we could do better.”

Opioid objectives

The new curriculum was drafted by a work group formed by Pennsylvania’s physician general, Dr. Rachel Levine. The work group included representatives from each medical school in Pennsylvania, including Ashburn and Dr. Eileen Moser, associate dean of medical education at Derry Township-based Penn State College of Medicine.

Together they developed a curriculum composed of four competencies, or learning objectives, that every medical school student should master before graduating.

The four competencies are: opioid pharmacology, in terms of how the drugs work and how they’re used; proper use of opioid pain medicine for acute and chronic pain; treatment options other than opioids; and how to identify substance use disorder and then refer patients for treatment.

Opioid education to be taught in clinical rotations

Penn State College of Medicine has mapped its curriculum to see where opioids are taught. The next step is to enhance it, Moser said.

The school is currently looking at what it could add to improve the lesson, but also how to convey the message so that it sticks.

For example, students may understand how to effectively treat pain, but they’re less confident of their ability to understand the risk factors that a patient might have for narcotic overuse, or they may be less able to identify patients who have substance use disorder, Moser explained.

The next step, after identifying substance use disorder, will be teaching future physicians how to wean those patients safely off of opioid pain medication.

The challenge, Moser said, is that it’s more than just teaching students a process and meeting a goal of hours per week to talk about opioids. It’s about teaching students safe opioid handling through actual patients and experiences, so that they grasp its importance.

“We know people are suffering. We know people are having bad effects due to opioid use. We know 10 people die a day. We know that,” Moser said. “It’s more than just teaching students. You could teach these concepts pretty quickly, but did the students truly learn them?”

Ashburn, at Penn Medicine, had a similar sentiment in that lecturing about opioids isn’t the most effective way to educate future physicians.

Teachers at Penn Medicine are increasing physician knowledge by integrating opioid education in existing clinical rotations, Ashburn said.

Pain care is found in almost every medical sub-specialty, but primary care doctors prescribe 60 percent of opioids, Ashburn said, adding, “That is clearly an important avenue for education.”

Penn Medicine is matching primary care physicians with pain specialists and addiction specialists so that the curriculum is integrated.

“I’m very excited about the legislation and very excited about the changes in medical school student education,” Ashburn said.