Medical schools to bolster opioid lessons
The state’s four medical schools have agreed to incorporate into their curriculum instruction in the prevention and treatment of prescription drug misuse, as part of Governor Charlie Baker’s effort to combat opioid addiction.
Under the agreement, expected to be announced Monday, the 3,000 students enrolled in the medical schools at the University of Massachusetts and Boston, Harvard, and Tufts universities will be taught skills designed to prevent painkillers from being misused.
The medical schools and the Massachusetts Medical Society, working with state Public Health Commissioner Monica Bharel, developed a list of 10 “core competencies.” Medical students will learn how to evaluate the risk of addiction before prescribing painkillers, how to treat patients at risk of substance use disorders before they become addicted, and how to understand and manage substance abuse as a chronic illness.
Medical school curriculums already address many of the issues, but the agreement aims to make sure that medical education throughout the state uniformly covers them.
“We must ensure that future generations of physicians are equipped with the requisite skills to successfully prevent, identify, and treat substance use disorders,” said Marylou Sudders, secretary of the Executive Office of Health and Human Services.
The announcement expected Monday from the Medical Education Working Group on Prescription Drug Misuse is the latest move by the Baker administration to cope with an epidemic of opioid abuse that claimed more than 1,000 lives last year.
“These educational standards represent an innovative and forward-thinking contribution to the state’s multifaceted strategy to curb the opioid epidemic,” Baker said in a statement.
“Massachusetts is again setting a new standard by providing our medical students with a strong foundation in treating those with substance use disorders,” the governor said.
When doctors prescribe painkillers too readily, their patients may become addicted or, more commonly, unused pills are taken from medicine cabinets for inappropriate use by family members or for sale on the street.
“What we’re seeing in the community suggests that there’s a problem in how many opiate doses are out there,” said Dr. Terence R. Flotte, dean of the UMass medical school. “Whatever we’re doing now is not good enough.”
The agreement aims to ensure that all medical students can tell if a patient is at risk of addiction to painkillers; know alternatives to opioids for treating pain; are familiar with ways to treat addiction; can develop treatment plans for pain and for addiction; are aware of their biases against people with substance use disorders; and know how to counsel people on behavior change.
The medical schools will independently decide how and when to incorporate the recommended instruction into their curriculums, but three deans reached Friday said they will move forward without delay.
Flotte hopes UMass can start immediately by enhancing simulations in which actors pretend to be patients to test the skills of third- and fourth-year students. The medical school will add simulations requiring the student to decide whether and how much to prescribe to a patient complaining of pain, Flotte said.
Meanwhile, UMass will assess its curriculum to see what additional instruction is needed. Flotte said he wasn’t sure whether major gaps exist. The group’s suggestions probably won’t result in new courses, he said, but rather in one-day or half-day seminars held as students transition into the third year and when they transition into internships.
Dr. Harris A. Berman, medical dean at Tufts, said the curriculum would be adjusted in time for the next academic year. “The students are anxious to learn about it,” he said. “They are well aware of the problem, just from growing up in America.”
Tufts already has a required course in addiction medicine. But now, information about treating pain and recognizing addiction will be added into course materials in surgery, pediatrics, and other topics.
Dr. Karen Antman, dean of the Boston University School of Medicine, said her school “has always had significant parts of our curriculum that dealt with addiction and preventing addiction.” The bigger changes will involve teaching safe prescribing and balancing the need to treat pain with the imperative to exercise greater caution.
“This will have a little bit of a snowball effect,” Antman said. “There will be small changes made but over time you’ll see it involving clerkships, electives, and the way we train learners and teams.”
Antman was reached Friday at a meeting of the Association of American Medical Colleges. “Everybody said [opioid addiction] was a major issue in their states as well,” said Antman, chairwoman of the association’s Council of Deans.
Following the lead of Massachusetts, she said, the association’s spring meeting will probably include discussion of how medical school curriculums can address the problem.