Preparing new doctors to battle the opioid crisis

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By Livia Gershon

As everyone knows by now, opioid drugs are part of a huge crisis in Central Massachusetts and across the country. The Massachusetts Department of Public Health estimates that more than 1,000 people died from opioid overdoses in the state last year, a 33-percent increase from 2012.

But the drugs are also an amazing boon to people suffering from debilitating pain. Those two facts make for a lot of tough calls by doctors who want the best for their patients.

A new initiative by Massachusetts’ four medical schools promises to help fledgling physicians navigate this difficult terrain. Together with state officials, the University of Massachusetts Medical School in Worcester, Boston University School of Medicine, Tufts University School of Medicine, and Harvard Medical School will develop a set of principles to teach medical students and resident physicians about pain management and prescribing opioids safely.

Dr. Dennis Dimitri, clinical associate professor at UMass Medical School, who also serves as president of the Massachusetts Medical Society, said the state’s medical schools have always done a good job addressing the dangers of opioids, but the current crisis presents an opportunity to look for ways to do even better.

“I think that the major issue is really just one of raising awareness of the number of people who have been impacted by nonmedical use of opioids and how much that has contributed to other societal issues and problems,” Dimitri said. “I think by raising awareness it just makes students, residents and others perhaps pay closer attention to things that they already knew.”

Dr. Michele Pugnaire, senior associate dean for educational affairs at UMass Medical School, said the new collaboration will build on a grant-funded project in which the four schools worked together to address problems of drug abuse.
“We have, I think, a strong foundation,” she said.

Pugnaire said it’s important that students receive good information and training around opioids regardless of what path they plan to pursue in medicine. She said the collaborative aspect of the project is also crucial because it means new doctors will have the same ideas reinforced from their first year of medical school through their residencies and into their professional careers.

“If you only intervene at one point along the pipeline, you’re not going to meet your goal,” she said.

Already, the Massachusetts Medical Society has been heavily involved in providing continuing education on the subject for practicing physicians. In May, it issued a set of guidelines for prescribing opioids. They include screening patients for family histories of substance abuse and behavioral issues, starting any opioid prescriptions with a short-term trial to assess the drug’s effects, and looking for situations where non-opioid medications may be a good alternative.

Also in May, the society made several online courses about opioids and pain management available for free to all prescribers. These include an overview of the opioid epidemic, a course on the use of alternative pain management techniques, and one on the legal issues around the mismanagement of opioids. The MMS says the courses have already been accessed 3,200 times.

In addition to educating current and future doctors, Dimitri said it’s important to raise public awareness about opioid abuse. Studies show that the vast majority of prescription drug abuse involves people using drugs prescribed to someone else, he said. That means it’s crucial for patients to be informed about keeping their medicine safe and disposing of any leftover pills so they don’t fall into the hands of someone with a drug problem.

Dimitri said another key piece of public education is letting teenagers know that just because a drug is legally prescribed does not make it safe to use recreationally.

“Unfortunately, there’s a fair amount of misunderstanding,” he said. “We need to do a better job of helping our youngsters and young adults better understand the risks of these drugs that they see as benign.”

Livia Gershon is a freelance journalist whose work regularly appears in the Worcester Business Journal.