Doubling down on opioids

Med school’s opioid curriculum is enhanced in its second year as crisis continues to worsen nationally

Campbell’s Jerry M. Wallace School of Osteopathic Medicine has “doubled down” on its year-old opioid curriculum in 2018 in an effort to fight the nation’s growing drug epidemic that took 63,600 lives in 2016 alone.

Additions to the curriculum — like sessions on recognizing and treating acute opioid overdose with naloxone and treating simulated patients who are abusing painkillers — came just months after President Donald Trump declared the nation’s opioid epidemic a “public health emergency,” mobilizing his Administration to address drug addiction and abuse in a more urgent manner.

They also come at a time when life expectancy in the U.S. has fallen for the second straight year — the first two-year drop in the country since the 1960s.

“The problem is getting worse,” says Dr. James Powers, the School of Medicine’s associate dean for clinical integration and interim chair of emergency medicine. “There were 646 opioid overdose visits to emergency rooms in North Carolina in August of 2017 alone. That was a 27-percent increase from the prior month. The cost of unintentional opioid-related deaths in North Carolina is in the billions now.

“These are recent numbers. And those numbers are trending up.”

Revisit our Spring 2017 cover story: Fighting the Opioid Epidemic

As reported in the cover story for the Spring 2017 edition of Campbell Magazine, North Carolina is home to four of the Top 20 cities in the U.S. for rate of opioid abuse — No. 1 Wilmington, No. 5 Hickory, No. 12 Jacksonville and No. 18 Fayetteville. Nationally, drug overdoses are now the leading cause of injury death, outnumbering both traffic crashes and gun-related deaths. The death rate from overdoses has tripled since 1999.

The blame for these numbers lies squarely with the nation’s addiction to painkillers.

The School of Medicine launched its opioid education program in January 2017, joining schools throughout the country to educate the next generation of doctors on the dangers of opioid abuse and addiction. Campbell’s program is an effort to not only teach proper pain management and how to work with patients who may be abusing these highly addictive drugs, but to also attack the root of what sparks addiction for many — the over-prescribing of opioids by family physicians and the criminal acts many patients will attempt to obtain more drugs.

In December, Powers joined Dr. Hal Elliott, chair of the school’s Department of Psychiatry, and Dr. Dan Marlowe, chair and assistant professor of behavioral health for a follow-up interview to last spring’s Campbell Magazine feature. Powers says new and future Campbell physicians will be “thrust into the front lines” of the opioid epidemic, and their role will be “hugely important” in reversing the growing overdose trend.

“Patients of doctors labeled as ‘high prescribers’ are more likely to go on to become chronic users of opioids,” Powers says. “So the front line is the key. We need to stop pushing opioids for things that can be treated just as well without using them. It’s the pathway to addiction.”

The curriculum won’t just benefit students in Campbell’s health sciences programs. In March, medical students will perform a grand rounds presentation on the opioid overdose-reversing drug naloxone for all faculty, staff and students. That drug has been responsible for nearly 10,000 lives saved in North Carolina since 2013, according to the N.C. Harm Reduction Coalition.

Later this spring, second-year medical students will treat simulated patients experience as opioid overdose. Other standardized patients will attempt to fake pain symptoms to receive prescriptions, according to Powers.

“There are so many red flags the students will be looking for — patients with multiple prescribers, patients who say they lose their medication or run out of their pills early,” he says. “Our students will have to learn to recognize these and then ask themselves, ‘How do you manage this patient?’”

According to Elliott, a big part of a Campbell medical student’s education is learning to better communicate with his or her colleagues across other health science disciplines.

“It’s a community effort,” he says. “When a physician has a patient presenting with pain and anxiety and asking for narcotics, they need to know the proper referrals to make and which providers to involve. This has generated really good discussion with our medical, our physician assistant and our nursing students.”

Campbell resident doctors are learning to assess and intervene patients who show signs of substance abuse, according to Marlowe. A multi-disciplinary, collaborative approach is key, so doctors, pharmacists, PAs and nurses approach patients with the same or similar treatment plans in mind. For example, a physician might set up a meeting with a psychologist if he or she feels the patient needs that extra step in their wellness.

Which leads to another big part of the Campbell curriculum — not just patient wellness, but the physician’s well-being as well. Marlowe says Campbell does a great job in promoting healthy lifestyles for it students, faculty and staff. The idea is that healthy, happy doctors will spend more time with their patients and encourage healthier, happier end results.

“Ultimately, it’s easy to prescribe someone a pill for their pain,” Marlowe says, “as opposed to sitting down and having a conversation with them to explore their options. And it’s harder for a doctor to do that when they themselves are mentally or emotionally exhausted. Physicians are actually more likely to abuse substances, because they have such easy access to it. But if you promote wellness now and they maintain it as a student, they’re more likely to maintain it down the line as well.

“We thoroughly believe how you conduct yourself as a student will determine how you conduct yourself as a professional.”