The opioid crisis

Host Lorenzo Norris, MD, returns this week for a dual-specialty episode on the opioid crisis and how it can be mitigated. He welcomes psychiatrist Martin Klapheke, MD, and family practice physician Magdelena Pasarica, MD, PhD, to talk about education, strategies, and collaboration between psychiatry and family practice medicine. In Dr. RK this week, Renee Kohanski, MD, talks about whether something is indeed better than nothing. You can contact the Psychcast by emailing us at [email protected] or you can follow us on Twitter at @MDedgePsych.   Show Notes By Jacqueline Posada, MD, 4th-year resident in the department of psychiatry & behavioral sciences at George Washington University, Washington.   Guests Dr. Martin M. Klapheke: psychiatry residency program director; assistant dean, medical education; and professor of psychiatry at University of Central Florida, Orlando Dr. Magdalena Pasarica: associate professor of medicine; medical director, KNIGHTS (Keeping Neighbors in Good Health Through Service) student-run free clinic; family medicine chair, Family Medicine Interest Group adviser at University of Central Florida, Orlando   How to address the opioid crisis during training The opioid crisis looms large over the medical field: 130 deaths from opioid overdoses per day. 11 million people misuse opiate prescriptions and 2.1 million people have an opioid use disorder. In 2018, the Department of Health & Human Services released a 5-point strategy in response to the opioid crisis: Access: Providing better prevention, treatment, and recovery services. Data: Offering timelier, more specific public health data and reporting. Pain management: Mitigating risk while prescribing with healthy, evidence-based methods of pain management. Overdoses: Targeting overdose-reversing drugs better. Research: Doing better research on pain and addiction.   Educating the next generation of medical professionals to address the opioid crisis From the family medicine and resident education point of view: Mitigate the risk when prescribing opiates. Identify opioid use disorder (OUD). Use the interdisciplinary approach to know when to refer to psychiatry and pain medicine. Primary care providers are on the front lines of the crisis, as 11% of patients report chronic pain. PCP will have to treat pain and: From the psychiatric and medical education point of view: Before opioid crisis, there was little instruction in how to treat acute or chronic pain. Medical education now teaches about pain management: Information about non-narcotic analgesics, nonmedication pain treatments, and addiction and its treatment. Medical students: Focus on working with family members of those with OUD and especially on using naloxone to reverse opioid overdose.   Interprofessional approach is most effective with communication with shared priorities We can collaborate effectively by understanding our shared priorities and offering all providers the opportunity to working toward these priorities in their own ways. From Dr. Klapheke: The opioid crisis crosses all specialties of medicine, and doctors will reach the limit of their expertise. Work interprofessionally by communicating and knowing what resources are available. Communicate what each party is doing for the epidemic and for the patient. This means knowing about resources in the hospital, clinics, city, county, law enforcement, etc.  From Dr. Pasarica: Again, we must acknowledge the limits of our expertise and work interdisciplinarily in a team-based approach. Each team member needs to be responsible for the follow-up, even if the patient is referred to another person such as a counselor or a psychiatrist. Each team member must share information and what has been done for the patient.   How is addressing the opioid epidemic being integrated into medical student and resident education?  From Dr. Klapheke: At University of Central Florida, the medical school uses vertical and horizontal integration of information into the curriculum. During the preclinical years: Write OUD and pain management into standardized patient work. Focus on the pharmacology of opiates and understanding neuroscience of addiction. During clinical rotations: Discuss OUD and the opioid epidemic during every specialty rotation and in lectures: Use simulations: For example, during the third year, treat a patient experiencing opioid overdose. Medical schools should take advantage of already created online resources to teach about substance use disorder and opioid use disorder. Educating medical students and residents to incorporate family members in treatment: Give family members information on chronic pain, addiction, and refer them to support groups. From Dr. Pasarica: There also is a focus on interdisciplinary care in clerkships and in the student-run free clinic. It is important to teach interdisciplinary care in clerkships and volunteer settings. Work with counseling students and pharmacy students to screen and manage substance use disorder. Visit treatment and recovery sites during medical school to see interdisciplinary work in action.   General ways to teach about the opioid epidemic in medical education: Focus on longitudinal educational experiences about pain and treatment. Focus on interdisciplinary care. Talk about pain in all different settings. Create simulations and online training modules. Use the medical school and GME network: Collaborate with other medical schools and hospitals about education and treatment. Address the stigma that occurs in the health care setting: Stigma is a barrier to patients and family accessing treatment. Nonjudgmental education about opioids, the crisis, and treatment can decrease stigma from health care providers. References Department of Health & Human Services: 5-point Strategy to Combat the Opioid Crisis  Association of American Medical Colleges News: “Responding to the opioid epidemic through education, patient care, and research.”