What do med students and prescribers need to know about opioid use disorders?

February 8, 2017


Caroline Miller, MSW
Outreach Specialist,
University of Wisconsin-Madison Division of Continuing Studies


Wisconsin Voices for Recovery partnered with the University of Wisconsin-Madison School of Medicine and Public Health on a Community Engagement Project to conduct a statewide survey of practicing physicians and medical students. The survey was a student-led effort and initiated because medical students felt that their current education on issues related to addiction, specifically the opioid epidemic, was inadequate. The findings highlight where Wisconsin needs to commit resources to improve the education of both students and prescribers, along with end stigma within the medical community.


Survey Details and Sample of Findings


"We learn about the neuropsychology of addiction, but do not learn how to effectively care for patients struggling with addiction, and how to address the existing stigma around addiction."       University of Wisconsin-Madison Medical Student
This survey (sample: 170 Medical students and 58 Medical Doctors in Wisconsin; majority of the MD responses were from Family Medicine Departments) assesses knowledge on the prescription drug monitoring program (PDMP), naloxone, best treatment practices for opioid addiction, as well as attitudes toward patients with a history of substance abuse, treatment of patients suspected of drug seeking behavior, use of addiction medicine consults in the inpatient setting, and other areas. Below is a sample of some of the findings from the survey.

1. Assessing student and MD knowledge on patients at highest risk of opioid related OD led to the finding that the majority of both MDs and students were incorrect, choosing the 23-year-old white male (59% students, 69% MDs); while only 25% students and 14% MDs were correct in choosing a 50-year-old white female.

2. Assessing knowledge on availability of naloxone: 49% medical students and 60% MDs were correct and a majority of both students and MDs support harm reduction strategies.

3. Assessing knowledge on best treatment of opioid use disorder (MAT plus counseling and support groups): 46% students and 57% MDs correct.

4. Assessing opinion on relapse likelihood: 40% students and 14% MDs believe relapse is likely regardless of treatment approach.

5. When asked who is responsible for the current opioid epidemic, the top three responses were the same for both students and MDs: healthcare professionals (overprescribing), pharmaceutical companies (marketing practices), and people with addiction or opioid use disorders.

6. Only 0.5% of students and 1% MDs would prescribe a female patient, 50 years-old, with 3 months of persistent pain despite 3 months of scheduled NSAIDS and PT with Oxycodone.
7. Majority of medical students (69%) and MDs (78%) have the opinion that sustained recovery is possible proper support (MAT, NA, 12-step program)

Conclusion


Medical students want to learn more about:
  1. How to talk to patients about addiction
  2. Non-opioid treatment options and their efficacies 
  3. Indications for using opioids, and how to prescribe them safely
Wisconsin Voices for Recovery sees the implications of this survey reaching far beyond the walls of a classroom. Should a follow-up survey be conducted? Are curriculum changes or additions important to consider for the University of Wisconsin-Madison School of Medicine and Public Health and other schools; and if so, should this process be expedited due to the current crisis in our state and nation?

There are many questions that still need answers, but this survey points to some thought (and research)-provoking topics. While a majority of students and MDs surveyed believe that recovery is possible with support, there are some in the medical community who still doubt this truth. Similarly, it leads one to question the impact of stigma on the medical community and how this may translate to patient care. It is up to the medical community – both professional and educational – to commit to learning about current trends and best practices in treating opioid use disorders, and being a catalyst for dispelling the myths about addiction. Recovery is a reality; and this concept should be a priority of the medical community – all communities – especially in times such as these.

Wisconsin Voices for Recovery would like to thank Dr. Randall Brown, from UW Family Medicine and Community Health, along with Skylar Chouinard and Aman Prasad from the University of Wisconsin-Madison School of Medicine and Public Health, for their contributions and support.


About our Guest Blogger


Caroline Miller is an Outreach Specialist with the University of Wisconsin -Madison Division ofContinuing Studies and Wisconsin Voices for Recovery project and Director of the John Adams Recovery Home for women. She is also the Director of Creative Consultation Services, LLC, providing consultation focusing on program development, capacity building, and communications for recovery-related initiatives and projects.
Contact Caroline at cmmiller5@wisc.edu






5 comments:

  1. So nice to see this subject addressed locally, especially with both doctors & med students. Was both interesting thorough. Look forward to a future follow up.

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  3. As the Clinical Director of a methadone/Suboxone clinic in Utah, one of the highest opiate death states, what we see the most is stigma and a complete lack of training on tapering patients from opiates to avoid addiction related issues. If doctors would be taught that prescribing opiates is an appropriate action IF they also have the conversation about how and when to taper off of them instead of prescribing for two months straight then stopping cold. This leads to doctor shopping or looking for opiates on the street including heroin. Its a simple physiological process. You explain tot he patient that physically their body will become dependent BUT that they will be stepped down slowly and safely and that within 2 weeks of a heavy opiate prescription they will be detoxed. I have heard doctors tell patients "If you are really in pain you wont become addicted". maybe not psychologically but physically you have no control over it. I think the backlash of not prescribing anything is a knee jerk reaction. If you are in acute pain, your body will not heal if you are unable to get relief and rest. so lets do this smart! That's how a clinic works: Get the client stable on replacement meds of Methadone or suboxone, then slowly taper them off so that within a year of counseling and tapering they are back to "normal".

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  4. I fully agree with the above statements from Ms. Williams.
    As a nurse for 23 years who now works at a DASA funded Treatment center in Illinois, I see and talk with every client that comes through our treatment Center.
    I will tell you that over-prescribing with no thought of tapering is by far the number one issue we face. Then once the client comes into treatment for recovery, the client is cut off because the Practioner is either embarrased, worried about being reported or just plain "knows better."
    Meanwhile, the cycle continues, the addicted mind finds a cheaper alternative and lives are forever changed...I would gladly work with any University out there to further gather data,etc. on this subject.

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