The State of Opioid Prescribing Education in U.S. Medical and Dental Schools

JENNA ADALBERT, BS

ASIF ILYAS, MD, MBA, FACS

SUMMARY POINTS

• In medical school curricula, active methods of opioid prescribing instruction (i.e. clinical practice scenarios) are suboptimal, with the greatest challenge in implementing opioid material being faculty expertise.

• While dental schools allot more curriculum hours to pain management than medical schools, there remains a deficit in opioid-specific prescribing content and assessment.

• As institutions implement AAMC and ADEA opioid curriculum recommendations, longitudinal review of student prescribing behaviors and open communication of new curriculum efficacy is key for quality improvement.

ANALYSIS

As key stakeholders and governing bodies respond to the opioid epidemic in the United States (U.S.), particular focus has been on medical and dental providers propagating the crisis through prescription opioids.1 In 2018, 46,802 overdose deaths (69.5% of all drug overdose deaths) in the U.S. were attributed to opioids, with prescription opioid overdoses comprising almost 32% of these deaths.2 While Americans constitute merely 5% of the global population, 80% of the world’s entire opioid supply and 99% of hydrocodone is consumed annually in the U.S., emphasizing the marked volume of opioids disseminated by U.S. prescribers for potential misuse.3 Of the many interventions targeting opioid prescribing patterns, one area of focus has been pain management knowledge and prescribing behaviors through healthcare student education.4 Given that this population comprises the future of U.S. prescribing, adjustments to the opioid curriculum of the highest volume prescribers, such as medical and dental students,5 have been recognized as a key intervention for opioid epidemic mitigation.4

In a 2017 survey conducted by the Association of American Medical Colleges (AAMC), medical school Deans at all accredited U.S. medical schools were asked to report their current or anticipated plans for curriculum adjustments to confront the opioid epidemic. The greatest challenge that emerged in implementing new medical school opioid curricula was a lack of faculty expertise with the subsequent ability to assess students on content delivery. Additionally, a deficit was identified in active methods of opioid prescribing instruction (i.e. clinically relevant practice scenarios), which are vital for training students to practice acting in their clinical roles as future providers. Effective strategies to address these inadequacies in medical student learning were identified as follows: sharing/publicizing standardized resources, emphasizing inter-professional teaching, integrating content longitudinally, engaging students through case based teaching/simulation practice, and increasing faculty capacity to teach responsible opioid management and prescribing behaviors.6

On August 30, 2017, the American Dental Education Association (ADEA) co-hosted a summit with the Substance Abuse and Mental Health Services Administration (SAMHSA) to discuss opioid epidemic trends and strategize how to better prepare dental students for their imminent role as opioid prescribers.7 Second to internal medicine physicians, dentists (specifically, general dentists and oromaxillofacial surgeons) were the second most common specialty group to prescribe opioids, distributing 8.6% (n = 18,091,864) of all opioid prescriptions in the U.S. from 2016 to 2017. 5 While dental schools traditionally allot more curriculum hours to pain management than medical schools, there remains a deficit of opioidspecific content and assessment on the effectiveness of delivery.8,9 The ADEA identified several key recommendations for remodeling of dental school curricula: collaboration between state dental schools regarding opioid curriculum structuring, establishment of statewide core competencies in opioid prescribing, creation of an opioid task force as a curriculum committee subgroup to assess and revise opioid content delivery, and training of faculty in best dental opioid practices.7

In response to the strategies devised by the AAMC and the ADEA, the majority of medical and dental institutions have started to uniquely assimilate opioid prescribing material into their curriculum structures.10,11 However, there remains no unified legislation or standardized opioid competencies required by regulating bodies.12 The variations in curriculum delivery between institutions and lack of preexisting teaching material interfere with easy implementation of a standardized opioid prescribing education at the national level. Yet, given the severity of the U.S. opioid epidemic, it will be imperative that medical and dental schools perform two key future steps ensuing curriculum adjustments: longitudinal review of student prescribing behaviors after they assume their role as providers and open communication of these results to collaboratively refine optimal training for our future prescribers.

REFERENCES

1. Understanding the Epidemic | Drug Overdose | CDC Injury Center. https://www.cdc.gov/drugoverdose/epidemic/?utm_source=EWSE+July+2017+Newsletter &utm_campaign=EWSE+Jul+2017&utm_medium=email. Accessed September 8, 2020.

2. Overdose Death Maps | Drug Overdose | CDC Injury Center. https://www.cdc.gov/drugoverdose/data/prescribing/overdose-death-maps.html. Accessed September 8, 2020.

3. Schommer J, Allen S, Scholz N, Reams M, Bohn D. Evaluation of quality improvement methods for altering opioid prescribing behavior in hand surgery. J Bone Joint Surg Am. 2020;102(9):804-810. doi:10.2106/JBJS.19.01052

4. Schnell M, Currie J. Addressing the opioid epidemic: is there a role for physician education? American Journal of Health Economics. 2018;4(3):383-410. doi:10.1162/ajhe_a_00113

5. Guy GP, Zhang K. Opioid prescribing by specialty and volume in the U.S. Am J Prev Med. 2018;55(5):e153-e155. doi:10.1016/j.amepre.2018.06.008

6. Addressing the Opioid Epidemic: U.S. Medical School Curricular Approaches | AAMC. https://www.aamc.org/data-reports/analysis-brief/report/addressing-opioid-epidemic-usmedical-school-curricular-approaches. Accessed September 9, 2020.

7. First-ever Regional ADEA–SAMHSA Summit on the Opioid Epidemic. https://www.adea.org/BDEBlog.aspx?blogid=27619&id=37741. Accessed September 10, 2020.

8. Doorenbos AZ, Gordon DB, Tauben D, et al. A blueprint of pain curriculum across prelicensure health sciences programs: one NIH Pain Consortium Center of Excellence in Pain Education (CoEPE) experience. J Pain. 2013;14(12):1533-1538. doi:10.1016/j.jpain.2013.07.006

9. Shaping the dentist’s role in addressing the opioid epidemic through dental education - DScholarship@Pitt. http://d-scholarship.pitt.edu/34133/. Accessed September 5, 2020.

10. Academic Medicine’s Response to the Opioid Crisis | AAMC. https://www.aamc.org/news-insights/opioids. Accessed September 10, 2020.

11. The Role of Dental Education in the Prevention of Opioid Prescription Drug Misuse. https://www.adea.org/policy/white-papers/preventing-opioid-prescription-drugmisuse.aspx. Accessed September 10, 2020.

12. Medical Education | AAMC. https://www.aamc.org/what-we-do/mission-areas/medicaleducation. Accessed September 10, 2020.