[The following notes were generated by Michele Haight, PhD.]

IAMSE Webinar Series, Winter 2020

Speakers: Sherry Jimenez and Jeremy Buchanan
Title: “Methods for Incorporating Opioid Education in Health Professions Curricula”
Series: How is Health Science Education Tackling the Opioid Epidemic?

• To address the statewide opioid crisis in Tennessee, in July 2018, as part of the Tennessee Department of Health, Tennessee Together effort, the Commission on Pain and Addiction Medicine Education developed 12 core competencies for use as a guide in developing opioid education curricula.
• Given the large number of health professions programs at LMU, the aims for interprofessional opioid education have been the following: integrate opioid education across the health professions’ curricula and connect the LMU students directly with the community to better learn challenges faced by patients, families, community service providers, etc.
• The DO, PA and NP health professions collaborated in the development of a day-long, Controlled Drug Misuse Symposium in 2018 which focused on best practices for substance use disorder prevention and non-prescription treatment options.
• Elements of this symposium included: pre/post survey questions, pre-reading materials and patient testimonials.
• Lessons learned from this symposium: the symposium was too long and there was not sufficient time for meaningful interactions.
• Two significant learner outcomes from this symposium were: increased knowledge about widespread controlled drug misuse and increased awareness of controlled drug misuse among themselves and others.
• A second interprofessional symposium was implemented in 2019 which focused on the Synthetic Opioid Surge.
• Aims for this symposium included: understanding the difference between synthetic opioid and opioids and describing different treatment models can contribute to positive health outcomes.
• This symposium incorporated the same format as the first symposium with an additional QR code for question submission. The symposium was shortened to half day and included a one hour 15 min. simulation with a patient who had overdosed. This simulation included actual community service providers (paramedics, police officers, etc.) and Standardized Patients. Although this simulation was a valuable learning experience for all, it was cumbersome in terms of time and compromised the speakers who presented afterwards.
• The 2020 symposium will be 4 hrs. long and focus on the relationship between adverse childhood events and opioid abuse. This event will occur in a much larger venue to better accommodate all interested parties and will be streamed to campuses in 4 other cities and 2 universities in the UK.
• To increase opioid awareness LMU, in collaboration with its other health professions schools, has created a short video which explores the interprofessional aspects of a vehicular collision scenario. The aims for this film are to promote team-based care and guide appropriate communication and interaction with other health care professionals.
• If you are interested in accessing this video or participating in the 2020 symposium (via streaming), please contact Dr. Jimenez or Mr. Buchanan at the following: Sherry.Jimenez@lmunet.edu, Jeremy.Buchanan@lmunet.edu
• Final thoughts: the process to develop and implement both the symposia and the video have been stellar examples of meaningful interprofessional collaboration. These types of collaborations can serve as models for how to move forward with developing and implementing interprofessional education.

[The following notes were generated by Michele Haight, PhD.]

IAMSE Webinar Series, Winter 2020

Speaker: Paul George
Title: “Integrating Opioid Use Disorder and Medication Based Treatment into Undergraduate Medical Education”
Series: How is Health Science Education Tackling the Opioid Epidemic?

• Rhode Island is the smallest state but one of the hardest hit by opioid overdose deaths.
• Life expectancy in the US has decreased in part due to the opioid overdose epidemic.
• Nationally, opioid prescription rates per population from 2000-2015 had a profound effect on the opioid overdose epidemic.
• Due to appropriate education, current physician opioid prescribing habits have changed and opioid prescription rates have tapered off. However, opioid prescription rates still remain a contributing factor to opioid overdose deaths.
• All medical school graduates need to be able to diagnose and treat opioid use disorder regardless of their specialty.
• The governor of Rhode Island mandated that all medical students be DATA (Drug Addiction and Treatment Act of 2000) waiver trained. Brown Alpert Medical School (AMS) enhanced its existing UME opioid use disorder curriculum to meet this requirement. This curriculum was reviewed and certified by the AAAP so that all Brown (AMS) graduates were certified DATA waiver trained in the state of Rhode Island. (There is now a federal pathway for US medical schools to obtain national certification for DATA waiver training.)

The Brown (AMS) Substance/Opioid Use Disorder thematic Curriculum across the UME Spectrum includes the following:

• Pre-Clerkship classroom curriculum: didactics on the science of pain, pharmacology of pain treatment, non-opioid and opioid pain treatments, non-pharmacologic treatment of pain
• Pre-Clerkship “Doctoring” curriculum: behavioral change and substance use counseling, SBIRT (Screening and Behavioral Intervention and Referral for
  Treatment), screening 5 patients for substance abuse disorder providing intervention and referral for treatment for positive screens, 1.5 hrs. interprofessional workshop (paper-based cases/team plan of care)
• 2 Week Clinical Skills Intercession Workshop (between years 2-3) pain management/opiates interprofessional 4 hr. workshop/patient panels/Standardized Patients
• Clerkship curriculum: documenting 5 substance use disorder patients (Internal Medicine/Family Medicine) providing interventions and referrals for treatment for positive screens, interactive workshops on pain and pain management (Internal Medicine, Family Medicine and Psychiatry), cases/sessions on chronic pain, evaluation and treatment of substance use disorders and substance misuse didactic session on MAT (medically assisted treatment)
• Proposed Year 4 curriculum mandatory 3hr. workshop with content on pain management and MAT-based cases

In partnership with the American Academy of Addiction Medicine, the Brown AMS curriculum also incorporates “outside” elements from the AAAM provider clinical support system.

• Recommendations for creating a Substance/Opioid Use Disorder curriculum: Make the curriculum integrated and longitudinal, make the curriculum interprofessional, partner with key stakeholders, use a variety of teaching modalities, link the curriculum across UME, GME and CME. (Private practice and community physicians are a high priority group for opioid
  education.)
• Final Thoughts: A waiver is not necessary for prescribing medications such as insulin or anti-hypertensives or oxycodone, etc., so what is the purpose of mandating a waiver for MAT for opioids? Perhaps it is time to rethink settings in which Methadone can be prescribed. LCME and ACGME need to include opioid education in their regulations.

[The following notes were generated by Michele Haight, PhD.]

IAMSE Webinar Series, Winter 2020

Speaker: Lisa Graves
Title: “Responding to the Opioid Crisis: An Educator’s View”
Series: How is Health Science Education Tackling the Opioid Epidemic?

• Statistics from the current health science literature underscore a progressive increase in opioid-related deaths and highlight the global scope of the opioid crisis.
• According to a 2017 bibliometric analysis in the NEJM, a one paragraph, Letter to the Editor published in 1980 in the NEJM (Porter & Jick) was largely responsible for advancing the opioid crisis through misinterpretation and misinformation.
• The antecedents of the opioid crisis in the medical literature provide a unique educational opportunity for all medical educators to guide learners to better interrogate and evaluate the literature used in clinical decision-making.
• Out of 43 papers reviewed in a 2019 scoping review for Substance Use Education in Medical Schools (Muzyk et al.), only one paper addressed opioids. The paucity of peer-reviewed literature targeting opioid use beckons medical educators to help fill this gap.
• The “AFMC Response to the Opioid Crisis” is a competency-based, bilingual, online curriculum that is currently under development in Canada. The proposed curriculum is designed to be spiraled, integrated and interleaved across all years of medical student training. The anticipated completion date for the pilot curriculum is 2021. For more information visit: https://afmc.ca/priorities/opioids
• Medical education strategies currently in use for addressing the opioid crisis include:
  Naloxone training for medical students
  DATA training waiver programs in the UME and GME curricula
  AAMC Opioid Crisis Summit, Washington DC, 2019
• Recommendations for the development of a comprehensive Substance Use Disorder Curriculum include the following:
  • Engage a broad swath of stakeholders including patients, patients’
    families, community organizations, community physicians, etc. in
    the development of a curriculum.
  • Create a non-stigmatizing lexicon and structured behaviors to
    communicate, discuss, teach and interact with all Substance Use
  • Disorder team members, especially residents.
  • Fuse the perspectives of substance abuse treatment providers and
    pain management providers to address the many psycho-social and
    economic complexities associated with the opioid crisis.
  • Review curricular interventions that have already been done and build
    on these.
  • Share methods, strategies and approaches that have been successful
    and those that have not worked to help others create a more
    informed curriculum.
  • Ensure that the curriculum can be adapted across the physician
    training continuum, UME, GME, CPD.