Tackling the Opioid Epidemic

About

AACOM recognizes that there is an urgent need to effectively address the opioid epidemic across the nation. Substance use disorders (SUDs)—especially those related to opioids—are threatening the lives of Americans: from 1999 to 2016, more than 630,000 people have died from a drug overdose. Furthermore, according to the Centers for Disease Control and Prevention, 40 percent of all U.S. opioid overdose deaths involve a prescription opioid. 

Osteopathic medical education is uniquely positioned to explore and support the educational needs associated with safe opioid prescribing and treating substance use disorders across the continuum of medical education, from the colleges of osteopathic medicine (COMs) to residency programs.

 

Read AACOM's statement on the opioid epidemic

AACOM Involvement with Federal Efforts

In October 2017, President Trump declared the opioid crisis a public health emergency. AACOM commends Congress for passing the SUPPORT Act and the Administration for recognizing the magnitude of this national crisis. AACOM remains actively engaged at the federal level to ensure policies are supporting effective treatment options and interventions and OME continues to play a key role in addressing the epidemic.

• AACOM Endorses Substance Use Disorder Workforce Loan Repayment Act of 2018
• Congress Passes Comprehensive Opioid Package
• Opioid Package Passes Congress; Awaits President's Signature
• AACOM Submits Comments on Draft Interim Report of the President’s Commission on Opioids
• AACOM Participates in White House Initiative to Combat Opioid Abuse
• AACOM Endorses Opioid Workforce Act of 2018
• AACOM Supports Senate and House Committee Efforts to Address Opioid Crisis
• Congress Advances Opioid Legislation; AACOM Endorses GME Bill to Combat Epidemic

Featured Federal Resources

• CDC Guideline for Prescribing Opioids for Chronic Pain
  • CDC Interactive Training Series
  • CDC Opioid Overdose Training for Providers
• CMS Opioid Prescribing Mapping Tool
• DoD/VA Joint Pain Education Program
• Free Medication-Assisted Treatment (MAT) Training
• HHS Pathways to Safer Opioid Use
• SAMHSA Providers Clinical Support System
• NIDAMED for Medical & Health Professionals
• NIH Pain Consortium Pain Education Interactive Modules
• ONDCP Rural Opioid Federal Interagency Working Group's Resources for Rural Communities
• VA/DoD Clinical Practice Guidelines
  • VA/DoD Clinical Practice Guidelines for Opioid Therapy for Chronic Pain

COM Engagement

Pain Management and Opioid Prescribing Curricula

All of the nation’s 35 COMs incorporate both treatment of pain and opioid prescribing curricula into their courses of study based on responses to AACOM's annual survey of the COMs. The Educational Council on Osteopathic Principles, a council of AACOM, has designed a curriculum that includes an additional 200 hours in musculoskeletal medicine, most of which focuses on the treatment of pain and functional enhancement through using OMM, a non-pharmacological treatment. (Source: Annual Osteopathic Medical School Questionnaire, 2017-2018 Academic Year.)

 The curricula at COMs address both pain management and the treatment of SUDs:

• 100% of COMs have required education addressing pain management.
• 86% of COMs have required education addressing the treatment of SUDs.
• 100% of COMs teach pain management and assessment using non-pharmacological modalities, specifically OMM.

Thirteen percent of COMs have required and 42% have elective experiential features, either early clinical experiences, optional clinical experiences, elective clinical clerkships, or standardized patient experiences in pain management.

COMs Addressing the Opioid Crisis

• Campbell University Jerry M. Wallace School of Osteopathic Medicine in Lillington, North Carolina, has launched the Opioid Abuse and Drug Abuse Curriculum designed to educate future physicians on both the benefits and dangers of opioids and alternative treatments for pain management. It helps medical students identify when patients are abusing their medications by providing practical guidance on screening pain patients for substance abuse disorder.

• Edward Via College of Osteopathic Medicine (VCOM) provides curriculum to more than 500 students per year on opioid prescribing with inclusion of CDC guidelines, beginning within the first block of curriculum. This curriculum is provided to students across all three campuses located in Blacksburg, Virginia; Auburn, Alabama; and Spartanburg, South Carolina. Through Clinical Skills Standardized Patient cases, which evaluate over 20,000 student/patient scenarios yearly across all three campuses, VCOM has noted a heightened awareness among students about the dangers of opioid prescribing. Moreover, VCOM is integrating education about addiction and opioid prescribing for third-year clinical medical students, and fourth-year students may choose an elective in substance abuse. VCOM also plans to develop an addiction medicine fellowship.

• Kansas City University of Medicine and Biosciences College of Osteopathic Medicine (KCU-COM) through its Pharmacology, Neurophysiology, and Behavioral Science Psychiatry courses during Years 1 and 2, addresses CDC guidelines for prescribing opioids for chronic pain, epidemiology, opioid pharmacokinetics, diagnostic criteria for physical dependence versus addiction, genetic and developmental predisposition, associated psychiatric disturbances and medical sequela, and medical treatments for opioid overdose and withdrawal. KCU-COM also uses case scenarios to teach students awareness of drug abuse issues and how to ask about and assess drug use in the primary care setting. KCU-COM led clerkships in an Integrated Behavioral Medicine Clinic are also incorporated to demonstrate practical clinical applications, including implementing CDC guidelines, devising effective treatment plans for intervention, and providing psychiatric support.

• West Virginia School of Osteopathic Medicine (WVSOM) in Lewisburg, West Virginia, utilizes simulation to teach medical students how to interact with patients who have overdosed or patients who are seeking drugs to fuel their addiction, which has been incorporated into WVSOM’s curriculum for more than five years. Additionally, WVSOM has endorsed the state attorney general’s strategy to reduce the use of opioids and aims to reduce the use of prescription opioids by at least 25 percent.

Opioid Resources with Focus on Graduate Medical Education (GME)

AAMC Resources

• AAMC Webinar Series “Innovative Educational Approaches to Safe Opiate Prescribing and Pain Management
  • 4/5/2017 webinar focused on approaches in undergraduate medical education (UME)
  • 4/6/2017 webinar focused on approaches in graduate medical education (GME)
  • 4/7/2017 webinar focused on approaches in continuing medical education (CME)

• AAMC Opioid Response Initiative/Efforts- Updated 12/03/2018
• Addressing the Opioid Epidemic: U.S. Medical School Curricular Approaches
• AAMC National Workshop on Medical Education and Opioid Misuse- May 2019 Summit

Journal Articles/Articles

• Improving Residents’ Safe Opioid Prescribing for Chronic Pain Using an Objective Structured Clinical Examination 
  Study on implementing a structured clinical examination for safe opioid prescribing as an educational tool for residents to deliver non-opioid chronic pain treatment.
• New, Nonopioid Pain Management Treatments Are Needed, Experts Say

Addiction Medicine & GME

• Opioid Use Disorder Resources
  
• The Opioid Epidemic as a Watershed Moment for Physician Training in Addiction Medicine
  Three ongoing obstacles to implementing training in addiction medicine:

1. Lack of time available to add new content in medical schools and residencies.
2. Limited number of preceptors who are qualified to teach medical students and residents in this are of medicine.
3. Challenges in recruiting for a fellowship (additional year in the fellowship).

• Evaluating Graduate Medical Education on Opioid Use Disorder in America’s Heroin Overdose Capital 
  • Inconsistencies in opioid training and significant gaps in faculty development for opioid training are two identified challenges.
  • Position statement by the Association of Academic Physicians calling for a new national strategy to address the diagnosis and treatment of pain via a functional approach to reduce the risk of opioid abuse and misuse.

• National Academy of Medicine Action Collaborative on Countering the U.S. Opioid Epidemic (several DOs included in steering committee and working groups, including Dr. Shannon and is chaired by Dr. Nasca) 

ACOEP:

• Role of Osteopathic Emergency Physicians In Safe Opioid Prescribing
• AOA Endorses Pathway to Subspecialty Certification in Addiction Medicine
• Medicine Responds to Addiction: Implementing Physician Training: Jan 30, 2018
• The American Osteopathic Academy of Addiction Medicine (AOAAM) website
• Basic Standards for Fellowship Training in Addiction Medicine in Osteopathic Family Practice and Manipulative Treatment

ABMS & Addiction Medicine:

• FAQ-Recognition of Addiction Medicine by the American Board of Medical Specialties: April 11, 2016
• ACGME Instructions Process Guide, Nov. 1, 2017
• Clinical Privilege White Paper: Addiction Medicine
• MedPage Today: ACGME a 'Game-Changer' for Addiction Medicine

Pain Medicine:

• FDA-Compliant Opioid Prescribing CME: CO*RE REMS CME Programs
• Opioid Prescriber CME Grants
• Federation of State Medical Boards Continuing Medical Education Board-by-Board Overview
• Improving Physician and Medical Student Education in Substance Use Disorders
• Medical Education in Substance Abuse: From Student to Practicing Osteopathic Physician

AOA Programs / Initiatives

• AOA FDA-Compliant Opioid Prescribing CME (AOA and CO*RE REMS CME program)
  • FDA-Compliant Opioid Prescribing CME: CO*RE REMS CME Programs
  • Opioid Prescriber CME Grants

• AOA’s Training in Policy Studies (TIPS) program gives residents an opportunity to initiate involvement in health policy issues. Sessions on the opioid epidemic are included in this program.

COM Opioid Initiatives/Events

• PCOM Community Partners in Fighting the Opioid Epidemic (CP-FOE) initiative
  Free 1-credit CME opioid education program
• RowanSOM Family Medicine Opioid Education Training Live Webinar (CME credit)
  • Focuses on opioid addiction in women
  • Addresses gender-responsive care practices in regards the opioid epidemic
• WVSOM’s Center for Rural and Community Health (CRCH) Prescription Opioid and Heroin Awareness Toolkit
  (collaborative effort with the Substance Abuse and Mental Health Services Administration, SAMHSA) – they presented their toolkit at the West Virginia Rural Health Conference in Fall 2017 during National Prevention Week.
  • WVSOM Promotes Opioid Toolkit Amidst National Prevention Week
  • Prescription Opioid and Heroin Awareness Toolkit
• Burrell College of Osteopathic Medicine Prescription Opioid Abuse Interprofessional Round Table Event
  Panel of speakers discussed the opioid epidemic in this interprofessional round table event in September 2018.
• CUSOM curriculum includes biochemistry of opiates and non-opioid medications as effective alternatives for chronic pain treatment

Grants

• Rowan University School of Osteopathic Medicine (RowanSOM) in Stratford, New Jersey, received one of 16 nationwide grants from the U.S. Department of Health and Human Services Office on Women’s Health to study opioid misuse and overdose prevention among high-risk women in the state. The project is expected to benefit the training of thousands of medical students, physicians, and patients over the project’s three years as RowanSOM will work closely with community learning centers, family medicine offices, and Area Health Education Centers to extend the reach of the project across six counties in southern New Jersey.
• The National Institute on Drug Abuse, in partnership with other federal agencies, awarded more than $500,000 to West Virginia University in 2017 to develop comprehensive approaches to address the opioid crisis in a project titled “Rural West Virginia Responds to Opioid Injection Epidemics: From Data to Action.” WVSOM will play a key role in the project’s implementation under the leadership of Drema Mace, PhD, the chair of the grant steering committee. In this role, Dr. Mace has connected local health leaders across the project’s focus areas and helped ensure the success of the integrated plan from testing to care delivery and social re-integration.

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Does your COM have an initiative addressing the opioid crisis or a new grant that you would like to include on this webpage? Contact us with details on your program.

Submit Your Initiative/Grant Details to AACOM