Years ago when a future doctor attended medical school they likely received little to no training in addiction. It is a more than reasonable expectation to have on medical schools that they train their students in a manner that reflects major public health issues like addiction. As the opioid addiction epidemic has continued to grow over the past several years, medical schools have been playing catch-up. They have added clinical rotations in pain management and addiction treatment, they are training doctors to differentiate between legitimate need for opioid painkillers and drug-seeking behavior and they’re learning to ask the right questions and intervene when necessary.
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Opioid Epidemic – A Flawed Philosophy
In the 1990s there was a significant philosophical shift in the medical community regarding opioids and pain management. Doctors and researchers felt that they needed to give patients the benefit of the doubt. They also felt as though it’s better to give out a few too many than not enough and allow some patients to suffer. At that point, they were unaware of the dire consequences of prescription opioids and the havoc they would eventually wreak. This philosophy was due in part to studies that demonstrated the effects of opioids on patients who legitimately needed them which showed low rates of addiction.
Opioid Prescriptions of Epic Proportions
Unfortunately, a significant amount of doctors began writing prescriptions for people who did not need these opioid medications. Pharmaceutical wholesalers filled orders for millions of pills to single small-town pharmacies in rural areas where addiction rates are at their highest. Many people became addicted to these pills and crime rates shot up as addicts committed various crimes to feed their addiction. Many of these opioid painkillers such as Oxycodone, Oxycontin, Hydrocodone, Oxymorphone and others were diverted from doctors offices, pain clinics and pharmacies to the black market, where they went for as much as $1 per milligram or more. In some parts of the country a single Oxycontin 80 mg tablet would sell for $120 on the black market. This exorbitant cost led some users to find cheaper alternatives; they found that heroin provided a similar high for a much cheaper cost. This is precisely how we ended up with the current heroin overdose epidemic that is costing us tens of thousands of lives every year, which is why it is so important that we educate and train doctors to understand the problem we are facing today.
Addiction and Pain Management Courses to Fight the Opioid Epidemic
Fortunately, many schools have now added addiction and pain management courses to their required curriculum. The doctors and professors who teach at medical schools which require addiction and pain management courses in their curriculum say that their goal is to ensure doctors graduate with two skills in particular; the ability to know the difference between when an opioid prescription is needed and when an alternative option is called for, and the ability to intervene when they realize one of their patients is exhibiting drug-seeking behavior. Furthermore the faculty at these medical schools wants to ensure that their students understand the full extent of the issue.
Opioid Epidemic a Significant Public Health Issue
Many of the doctors who recently graduated from medical school who received this training say it has been an enormous help to have insight into this significant public health issue. Many of these graduates also say this training has helped them decide whether or not to prescribe an opioid drug in many cases. Dr. Kevin O’Day is an internal medicine resident at the University of Massachusetts School of Medicine. He graduated from the University of Massachusetts School of Medicine in 2016, where he received extensive training regarding prescription opioid abuse and addiction. He said his training at the university “made him feel more comfortable and confident in himself, knowing not only when to say no but also when to say yes.” University of Pennsylvania Perelman School of Medicine student Nadir Bilici made a similar claim stating, “it has been useful to understand the challenges that patients with drug addiction face beyond receiving clinical treatment, we have learned how various socio-politico-economic factors go into making and breaking communities of addiction.”
Experts say it is important for up and coming doctors to avoid either overprescribing or underprescribing opioid medications, because most areas of medicine including surgery and primary care eventually require the use of opioids. It’s just as important to avoiding getting patients addicted as it is to avoid allowing legitimate pain management patients with chronic pain to suffer. This is why medical schools have been educating their students on non-narcotic alternatives. This allows doctors to kill two birds with one stone; they decrease their patients suffering while avoiding a potential issue with addiction.
A Life or Death Responsibility
For a long time, medical schools didn’t teach aspiring doctors anything about addiction. Patients were given addictive narcotics for all sorts of ailments and no one thought anything of it. Now unfortunately we’re in the midst of the worst opioid addiction crisis in our nation’s history. If doctors aren’t being properly trained then we really have no chance of solving this crisis. Doctors play a huge role in avoiding diversion of narcotics to the black market. They assess patients on a daily basis and have the difficult task of determining who needs opioids and who doesn’t. Luckily schools are now starting to do their part in preparing doctors for this enormous life or death responsibility.
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