New training required
Don J. Selzer, MD, MS, FACS, FASMBS, surgeon, Indiana University Health, and associate professor and chief of the division of general surgery, Indiana University School of Medicine, Indianapolis, Indiana, says more medical schools are recognizing and teaching the potential for development of dependency and training physicians about multimodal pain therapy that uses ancillary medications, including non-steroidal anti-inflammatories, acetaminophen, and local anesthetics.
Davis says medical schools are at different places regarding their interventions targeting the opioid epidemic. “For us, it is important to have a coordinated approach, so that we can teach skills and assess them over time and in multiple contexts—in the classroom, clinic, hospital, and with the participation of other professions such as pharmacy and nursing,” he says. “In most cases, schools have taken into account aspects of the surrounding community and its needs. We are in the process of looking at education statewide to address our community’s needs as the epidemic evolves.”
Davis says training should continue after students graduate. For example, at Ohio State, emergency medicine residents are trained on how to communicate with patients and families affected by opioids. Davis advocates for broad incorporation of such training, including use of simulation, to further the development of patient care skills relevant to the opioid epidemic.
Touro College and University System brings in community members to tell personal stories of use and abuse. “Businessmen and women and ex-convicts alike tell stories to put a personal face on the epidemic,” Goldberg says. “Special U.S. Drug Enforcement Administration prosecutors are invited to talk to the student body about risk management and personal responsibility. They cite the CDC’s statistics to portray the epidemic’s scope.”
Darren Freeman, DO, director of pain management, University of California Riverside School of Medicine, Riverside, California, says training on compliance with state and federal regulations is also helpful. “All providers who prescribe opioids are required to be registered with the Controlled Substance Utilization Review and Evaluation System (CURES) and must check this database of controlled substances quarterly for any potential overdoses as well as administer urine toxicology screening twice annually,” he says. “The goal is to attempt to minimize the need for opioids, and provide multimodel regimens including medications, i.e., non-steroids, antidepressants, anticonvulsants, muscle relaxers, cardiac or blood pressure medications, or topical agents which have all demonstrated great efficacy in pain control. This is based on the understanding that other conservative treatments should be provided, including alternative modalities.”
Karen Appold is a medical writer in Lehigh Valley, Pennsylvania.