New education on opioid use disorder aims to stop opioid addiction before it starts
Since the late 1990s, the United States has struggled to fight the opioid epidemic that continues to ravage every corner of the country. Opioid use disorder (OUD), the chronic misuse of opioid medications, impacts people of all social, economic and educational backgrounds. OUD doesn’t just refer to street drugs — many people who develop an addiction are prescribed opioids by their health care providers to treat pain or chronic disease.
Because health care providers care for patients after surgeries and throughout the management of chronic conditions, they have an increasingly important role within the epidemic. When deciding whether to prescribe opioids for a patient, physicians need to weigh the benefits of pain relief against the risks of addiction. Although this choice can be challenging, providers are in a unique position — their prescribing behaviors have the power to stop an addiction before it starts.
Because Ohio serves as ground zero for the epidemic, The Ohio State University College of Medicine recognizes the critical impact providers can have on OUD, says Julie Niedermier, MD, clinical professor in the Department of Psychiatry and Behavioral Health. The college’s physicians and researchers have been developing new initiatives to combat the growing crisis, including an OUD curriculum that focuses on educating medical students about patient opioid use.
The work at the college targets the provider side of the epidemic, focusing on increased opioid training and preparation to ensure health care professionals understand how to treat and make crucial decisions about patients with OUD. The Ohio State College of Medicine is “ahead of the game,” as Dr. Niedermier puts it, because of the heavy toll opioid use has taken on the Columbus community.
New opioid use disorder curriculum prepares medical students for ‘patients desperate for help’
A team of professionals led by addiction medicine faculty in the Ohio State College of Medicine’s Department of Psychiatry and Behavioral Health created and implemented the new, cutting-edge OUD curriculum. It was built to prepare future physicians to confidently handle the treatment of chronic and acute pain while addressing the needs of patients and families who have been affected by the opioid epidemic.
Because of the extensive nature of OUD, the curriculum needed to be comprehensive as well, so it was jointly designed by medical professionals from many specialties, including Dr. Niedermier.
“It’s the idea that we will have 200+ medical school graduates each year who will hopefully have the tools they need to provide care for patients with substance use disorders or recognize when and how to get a patient connected to appropriate care,” Dr. Niedermier says. “We’ve tried our best to emphasize that whether you’re a generalist or specialist, you will see patients with opioid use disorder.”
The OUD curriculum includes three parts that follow students through their entire four-year medical school career. The first part emphasizes lectures and basic opioid knowledge during a student’s initial two years of medical school. When students enter their third year, the second part of the curriculum introduces hands-on clinical experiences and training for basic pain management. The final part of the curriculum, which occurs during the fourth year of medical school, allows students to apply their advanced knowledge to manage more complex cases of acute and chronic pain in patients.
According to the data Dr. Niedermier and her colleagues have collected so far, most students who completed the OUD curriculum reported their knowledge of opioids and pain management had significantly increased. This is a promising sign that the curriculum successfully prepares medical students to treat patients with OUD.
Dr. Niedermier explains that although she’s seen other medical schools implement similar opioid education programs, none of them are as longitudinal or fully integrated as the one-of-a-kind OUD curriculum at Ohio State.
“Having the buy-in of the College of Medicine was important because leaders were very receptive. All the providers were receptive because they’re seeing patients desperate for help. Physicians want to do anything to get better outcomes for our patients and not have them come to the emergency department after overdosing multiple times,” Niedermier says.
Surgery recovery leaders strive to change how physicians prescribe opioids
Other health professionals at Ohio State are focusing on alternatives to opioids and the role physicians can have in preventing OUD. Kristin Brower, PharmD, a pharmacist for Perioperative Services at The Ohio State University Wexner Medical Center, is part of a group focused on spreading awareness about “multimodal analgesia” and the data that supports its promising role in decreasing opioid use.
Multimodal analgesia, or multimodal pain management, refers to giving patients medications from several different drug classes, as opposed to only using opioids to control pain. When taken together, each of these drugs targets a separate mechanism or part of the body’s pain pathway. This can produce a synergistic effect — in other words, multiple types of drug classes acting together can have combined impact, decreasing pain more effectively than a single class of drug normally would.
“I am hoping the work that we do helps physicians realize that controlling the opioid crisis is something we can directly impact with prescribing patterns,” Dr. Brower says.
Dr. Brower works with many others from the Ohio State College of Medicine as part of the Enhanced Surgical Recovery (ESR) protocol, directed by anesthesiologist Michelle Humeidan, MD, PhD, at the Ohio State Wexner Medical Center. The ESR team strives to achieve early recovery for surgical patients by decreasing the number of opioids prescribed before and after surgery.
Leaders of the ESR protocol believe informing medical professionals about multimodal analgesia will help providers recognize the influence their decisions can have and how they can use their direct patient connections to stymie the opioid epidemic.
“Our ESR group was very focused on educating the physicians that, if we can decrease inpatient opioid use, we can decrease the amount of opioid we discharge the patients on and thus decrease the amount of those medications out in the community,” Dr. Brower says. “It has been a pleasure to provide both formal education and informal education on rounds to my teams about the impact that we can have on these patients, both with improved pain control and decreased utilization of opioids.”