A program at the Warren Alpert Medical School of Brown University, described by officials there as the first of its kind nationwide, is creating physicians equipped to treat opioid-use disorder at the outset of their graduate medical education.
More than 30 medical students who graduate from Brown’s program in 2018 will obtain the necessary credential to prescribe buprenorphine, which can aid in the treatment of the disease. By 2019, every Brown medical school graduate will qualify.
The federal Drug Abuse Treatment Act of 2000 (DATA 2000) mandates physicians undergo at least eight hours of training to prescribe buprenorphine. During their medical school curriculum, Brown medical students undertake 23 hours of coursework that informs treatment of opioid-use disorder. That workload, the Rhode Island Department of Health has determined, qualifies them for a DATA 2000 waiver.
The program at Brown, a member of the AMA's Accelerating Change in Medical Education Consortium, is the result of collaboration between the state government and several medical institutions within Rhode Island.
“Our governor [Gina Raimondo] has made addressing the epidemic a huge priority,” said Paul George, MD, assistant dean for medical education at Brown. “This is an issue that doesn’t only affect primary care doctors or addiction medicine specialists. It’s something that physicians from every specialty are going to see in their practices and have to treat at some point. The more physicians we train to be able to properly prescribe opioids or other pain-management strategies, the better. The number of physicians we can train to be able to recognize opioid misuse and be able to provide intervention and referral for treatment, the better.”
Inculcating a different approach to pain
Throughout the country, about 33,000 physicians have obtained the DATA 2000 waiver, according to a report in the American Journal on Addictions. Less than half, however, are offering medication-assisted treatment for opioid use disorder.
James McDonald, MD, MPH, is the chief administrative officer of Rhode Island's Board of Medical Licensure and Discipline. He says there are about 120 physicians in Rhode Island who actively prescribe buprenorphine to treat opioid-use disorder. The Brown program aims to increase that number, but its scope goes further.
“What we’re interested in is really getting the current generation of physicians to approach their new profession differently,” Dr. McDonald said. “It’s not just about medication-assisted treatment. Sometimes we learn from our trainees more than we teach our trainees. That’s what we are seeing with the new GME [graduate medical education]. The new residents are the ones who have different training when it comes to pain management. They look at pain differently; they are more likely to collaborate.”
Now, the DATA waiver qualification for Brown medical students is only applicable in Rhode Island. The hope is that both the waiver and the program will expand beyond the state.
“This is a key thing, that Rhode Island did this and other states can offer reciprocity through their state medical boards,” Dr. McDonald said. “It really gets to the larger issue. If other medical schools could adopt a similar curriculum to what Brown has done, there’s a lot more to be gained here than prescribing medication-assisted treatment. It standardizes, to a larger degree, the current generation’s medical education about appropriate management of pain and opioid-use disorder. That is, really, almost more valuable.”
Supporting access to comprehensive, affordable, compassionate treatment for opioid-use disorder is one of the goals of the AMA Opioid Task Force. The task force also has been working to:
- Support physicians’ use of effective PDMPs.
- Enhance education on effective, evidence-based prescribing and treatment.
- Put an end to stigma for patients with chronic pain or substance-use disorder.
- Expand access to naloxone in the community and through co-prescribing.
- Encourage safe storage and disposal of prescription medication.
The AMA offers online CME to expand your understanding of the opioid epidemic. Explore educational content such as "A Primer on the Opioid Morbidity and Mortality Crisis: What Every Prescriber Should Know."