This article is the 17th in a series about the epidemic of opioid addiction and how NEOMED is training future physicians and pharmacists to help.
Students are interested, and often times excited to discuss if CBD oil and THC might be considered as part of a pain management program, says Sarah Adkins, Pharm.D. She understands their interest. But that topic is just one aspect of a much larger discussion, related to the national conversation around how to stem the overuse of opioids, that she raises with students at the Heritage College of Osteopathic Medicine at Ohio University.
Dr. Adkins presented highlights of a course she helps instruct and solicited feedback from her teaching peers during the Curriculum Summit of the All-Ohio Medical School Opioid Use Disorder Collaborative held at NEOMED, Aug. 29-31.
While pieces of good training have been available, a full complement of training in how to treat for substance abuse disorder – specifically, opioids — needs to be enhanced in medical school curriculum, Dr. Adkins said after her presentation. “The details about potential for addiction and the disease states of addiction need to be fully addressed,” she said.
So, Dr. Adkins has been all in for a federally funded project led by NEOMED to develop curriculum that can be used in all seven of Ohio’s medical schools, tailored to the needs of each institution.
Three days of collaboration and training
Thursday, Aug. 29, 41 participants, representing all seven Ohio medical schools, moved from room to room in the NEW Center as they took in a lineup of 29 curriculum sessions ranging from Dr. Adkins’ “Non-Opioid Treatments for Pain Management” to “Opioid Use in Older Adults: Simulation Education,” presented by NEOMED’s Geriatric Workforce Empowerment (GWEP) team. Students and Standardized Patients participated, too, in demonstrations of hands-on training sessions for handling overdose situations, led by MetroHealth Medical Center.
Friday, Aug. 30, primary care supplemental training was offered to 17 physicians, including motivational interviewing sessions and instruction in office-based treatment with buprenorphine. Saturday, Aug. 31, a full day of SAMHSA/ASAM Medication Assisted Treatment (MAT) certification training was offered to nine prescribers and 10 NEOMED fourth-year College of Medicine students.
Best practices for a new curriculum in pain management
When teaching at Ohio University Heritage College of Osteopathic Medicine and precepting with The Ohio State University College of Pharmacy, Dr. Adkins draws on best practices for pain management from a comprehensive inter-agency task force report* issued in May 2019 by the Department of Health and Human Services.
With her training as a pharmacist, she certainly believes in using medication, Dr. Adkins told the group assembled. But she advises her students to begin without medication when possible, and/or to begin medication treatment with low doses.
She tells resident physicians, who can sometimes be skeptical of alternative treatments, “It's important to provide options. Discuss these options as an appropriate possibility for treatment.” Her perspective is that understanding more evidence-based options, and presenting complementary therapies initially, then moving to medications, can only benefit patients.
For example, for a patient who suffers from inflammation, Dr. Adkins talks with students about potential alternatives. Acetaminophen is an over-the-counter medicine that may work well for some patients, but many people don’t know about its potential for liver toxicity, so that’s a topic that health care providers need to be sure to discuss with their patients.
And restorative therapies or procedures including cold and heat, massage therapy, acupuncture, osteopathic manipulative medicine and meditative movement such as yoga or tai chi are options for treating discomfort or pain from inflammation or other causes, says Dr. Adkins.
“The effort is to educate our young people so they understand the consequences of opioid addiction —and how to treat drug addiction,” Dr. Adkins said.
A statewide curriculum initiative
Funding for the All-Ohio Medical School Opioid Use Disorder Collaborative came through a $500,000 grant from the Ohio Department of Mental Health and Addiction Services (OhioMHAS). NEOMED received the grant to work with the other six medical schools in Ohio in a collaborative effort to develop a common curriculum on pain management and opioid use disorder (OUD) treatment. The other schools are Case Western Reserve University, Ohio University, The Ohio State University, the University of Cincinnati, the University of Toledo and Wright State University.
“The curriculum is designed to be comprehensive and flexible. It can be easily adapted for multiple levels of learners and for a variety of courses,” says Stacey Gardner-Buckshaw, Ph.D., the Co-Principal Investigator for the grant.
In the coming months, each of the seven medical schools will review its own curriculum, implementing new content and considering revisions suggested by the collaborative. Each institution will integrate changes to meet its own curricular needs.