Academic medicine leads efforts to address the opioid epidemic

AAMC President and CEO Darrell Kirch, MD, lauds the nation’s medical schools and teaching hospitals for their multifaceted efforts to tackle pain management and opioid use disorder.
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Tragically, 130 people die every day in this country from an opioid overdose. About 2 million Americans were living with opioid addiction in 2017, according to the Centers for Disease Control and Prevention.

Medical schools and teaching hospitals see the effects of the epidemic every day in their communities. When the mortality rate for opioid use disorder started to accelerate in 2013, concerns were raised that the problem somehow reflected a failure in medical education.

The reality is that the academic medicine community has taken on this challenge and played a key role in confronting this epidemic. In fact, teaching hospitals treat a disproportionate percentage of people experiencing an opioid overdose. Beyond that, our medical schools and teaching hospitals have enhanced their focus on pain and addiction in the classroom and have developed better treatments through research and new models of care. This trifold response of medical education, research, and new, more effective treatments is an example of academic medicine at its best.

The range of what our institutions are doing is extensive. Some are investigating nonpharmacological and nonaddictive methods for treating pain, while others are on the frontline working to narrow the troubling gap in treatment access for patients struggling with OUD in rural and underserved areas. Fellowships in the new subspecialty of addiction medicine are being created. In addition, the AAMC is partnering with the National Academy of Medicine Action Collaborative on Countering the U.S. Opioid Epidemic to leverage broad-based solutions that connect multidisciplinary organizations whose support is critical.

Our medical schools and teaching hospitals have enhanced their focus on pain and addiction in the classroom and have developed better treatments through research and new models of care.

The medical education community also has stepped up to better prepare new doctors by expanding addiction and pain management content in their curricula, creating simulated patient exercises, identifying related competencies, and weaving more case-based instruction through all four years of medical school. According to an AAMC survey, 87% of the 147 medical schools surveyed in 2017 address all four domains related to pain and substance use disorders (SUDs) in their curricula, and 100% of our medical schools address at least two of the four key domains. In addition, many residency programs now include best practices for safely prescribing pain medication or training on buprenorphine and medication assisted treatment.

To facilitate information-sharing, MedEdPORTAL® launched a call for submissions for curricular content addressing pain management, addiction medicine, and opioid education. Published works will be available in a featured collection to download, implement, and build on. AAMC-sponsored webinars and meetings also provide opportunities to share information and best practices.

Through our work, I see us making progress in removing the stigma attached to SUDs — with the public and among health professionals. More important, public health officials are cautiously optimistic about preliminary data from the last year that show the first decline in deaths from prescription painkillers since the opioid epidemic started.

Bringing together the medical education continuum

At the AAMC, we are particularly excited to host a workshop in May that will bring together the entire medical education continuum — more than 300 key leaders in undergraduate, graduate, and continuing education — who will identify what is working well in teaching and assessment, plus the areas needing improvement. We anticipate this national workshop will be a catalyst for disseminating innovative practices among our members.

Academic medical researchers are continuing to explore nonaddictive drugs for pain relief, nonpharmacological methods of pain treatment, and better ways of treating patients who overdose.

Also at the workshop, we will celebrate our 2018 Curriculum Innovation Award winners who have advanced knowledge about pain and addiction training in medical schools. Kudos to the University of Massachusetts Medical School, University of Michigan School of Medicine, Uniformed Services University of the Health Sciences, and Warren Alpert School of Medicine at Brown University.

Furthermore, the AAMC will be awarding five challenge grants for new training, tools, or strategies to increase faculty proficiency in the areas of pain and substance use disorders, or improve integration of that content in undergraduate, graduate, or continuing medical education curricula. The deadline for proposals is June 7, 2019.

Treatment, research, and advocacy

Through new pain management protocols, academic medicine physicians have become more effective in finding the right balance between treating pain and preventing opioid overuse while others are identifying more effective ways to connect patients with SUDs to treatment.

Researchers at Yale School of Medicine, for example, found that bridging handoffs between acute and long-term care for SUD patients in the emergency department is a key factor in outcomes. Providing medication-assisted treatment along with long-term care referrals greatly increased the chances the patient would continue treatment after 30 days versus those only given a treatment referral or counseled briefly. More teaching hospitals are replicating this new model of care. This kind of innovation — that sets the standard for care — is another example of academic medicine at its best. Likewise, I applaud the academic medical centers that have partnered on drug takeback events, increased naloxone distribution, and trained providers outside their institutions on treating patients who overdose.

Through research, scientists have made great strides in expanding knowledge about pain and the biology of opioid addiction as well. Academic medical researchers are continuing to explore nonaddictive drugs for pain relief, nonpharmacological methods of pain treatment, and better ways of treating patients who overdose.

Academic medicine is playing a key role in the solution as we bring together the education of tomorrow’s doctors and other health professionals, with discoveries in medical research and advances in patient care.

Finally, on the policy front, the AAMC has held briefings on Capitol Hill and advocated for legislation to increase the number of physicians with specialized expertise in addiction or pain. The AAMC supports the bipartisan Opioid Workforce Act of 2018 which would provide Medicare support for 1,000 more graduate medical education positions over the next five years at hospitals with residency programs in addiction medicine, addiction psychiatry, or pain management. Currently, only a fraction of people with SUD receive treatment, partly due to a dearth of providers specialized in treating addiction.

Opioid use disorder is a massive public health crisis for our nation. Academic medicine is playing a key role in the solution as we bring together the education of tomorrow’s doctors and other health professionals with discoveries in medical research and advances in patient care. We still have a long way to go, but I am proud that our institutions are at the forefront of new and better solutions to end this national epidemic.

Editor’s note: For specific examples of what the nation’s medical schools and teaching hospitals are doing to end this problem, read How Academic Medicine Is Addressing the Opioid Epidemic.