Despite an unprecedented opioid epidemic in the U.S., medical schools across the nation have been failing to adequately prepare students to treat addiction and overdose.
In March, the White House urged medical schools to sign a pledge to include new opioid prescription guidelines in their curriculum. Out of more than 170 medical schools, the pledge received only 61 signatures. Harvard Medical School abstained, stating that its curriculum was comprehensive enough.
But students disagreed.
Harvard students took it upon themselves to research treatment options for opioid addiction and teach others how to respond to overdose. They began raising awareness about naloxone, a drug that reverses opioid overdoses.
The students also reached out to local pharmacies to find out if they would sell naloxone over the counter.
“We were the first people to ask,” said Siva Sundaram, a Harvard Medical School student. “Pharmacists didn’t know what to do.”
The recent surge in prescription opioid deaths highlights the lack of training in opioid abuse. The rate of opioid overdose deaths has nearly quadrupled since 1999, according to the U.S. Department of Health and Human Services.
Stanford Paves Way for Improved Addiction Training
A five-year study by The National Center on Addiction and Substance Abuse disclosed that medical schools are not devoting enough time to teaching students about addiction medicine. The 2012 report recommends that all medical schools and residency training programs should train doctors to address substance abuse and addiction.
While more work needs to be done, the growing overdose epidemic has led several medical schools to change their curriculum to accommodate a comprehensive substance abuse course.
Stanford University School of Medicine implemented the Addiction Medicine Fellowship, a one-year program that educates students on the multiple facets of substance abuse treatment.
The program teaches students about:
- Detoxification
- Pharmacotherapy
- Abstinence-based recovery models
- Harm-reduction recovery models
- Motivational interviewing
- 12-step approach to treatment
- Consultation for medical and psychiatric hospital services
- Psychosocial approaches to addiction treatment
Aside from the fellowship, the university took measures to provide stand-alone addiction lectures instead of merging them into the psychiatry series. Prospective doctors from every discipline will continue the addiction training in clinical rotations.
“We’re at the very bottom of a very long uphill road,” said Dr. Anna Lembke, director of the fellowship.
Students from Harvard Med and three other medical schools in Massachusetts believe that medical professionals need to destigmatize addiction and stop viewing it as a vice.
Because of some physicians’ longstanding belief of addiction not being a disease, schools have refrained from integrating comprehensive addiction education into their existing medical programs.
In fact, a March 2016 report by the California Health Care Foundation named insufficient medical school training as one of the main challenges in addiction treatment.
“We are over 10 years into this epidemic, and I don’t think we’ve seen a robust enough response from the medical community,” said Michael Botticelli, director of the White House Office of National Drug Control Policy.
A Growing Need for Addiction Medicine
Most doctors were unprepared to deal with patients suffering from a substance use disorder, according to the CASA report. They either failed to diagnose substance abuse or did not know how to treat addiction patients. The American Medical Association estimates only 582 of the 985,375 active physicians have specialized training in addiction medicine.
With the latest research from SAMHSA showing 21.5 million people 12 or older had a substance use disorder in 2014, the need for a stronger focus on addiction medicine is undeniable.
The availability of medications that treat addiction and overdose has improved in the last 10 to 15 years, but not enough physicians are being trained to use them.
“You need a workforce who understands and can prescribe these drugs appropriately,” said Wilson Compton from the National Institute on Drug Abuse.
Several Massachusetts schools have taken steps to prepare their students to meet this need.
In November 2015, Massachusetts Governor Charlie Baker collaborated with state medical schools to improve their existing curriculum by developing a set of 10 key skills for safely prescribing opioids and treating addiction.
The University of Massachusetts integrated an obligatory course on opioids that includes clinical sessions. Boston University is looking to train its basic life support class to use naloxone, and Harvard aims to lay emphasis on addiction in two of its preclinical courses by September 2016.
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