Sixty Medical Schools Expanding Curriculum to Address Prescription Opioid Abuse

More than 60 medical schools across the United States were recognized by the White House this week for pledging to teach medical students about the dangers of prescribing opioids to patients for pain. The pledge confirms participating medical schools will include new guidelines from the U.S. Centers for Disease Control (CDC) on the use of prescription opioids – and comes in conjunction with President Obama’s announcement of additional public-private efforts to fight the nation’s epidemic of prescription opioid and heroin abuse that kills tens of thousands of Americans every year.

The prescriptive use of opioids has direct ties to the nation’s growing heroin epidemic – the CDC reports three of four people using heroin began with prescription opioids, making such prescriptions gateway drugs to the highly addictive street narcotic.

The University of Central Florida (UCF) joins medical schools like Tulane, Tennessee, Ohio State and Baylor (see complete list below) that will require medical students to get increased training in prescribing such pain medications before they graduate. UCF will begin the expanded curriculum in the fall.

“All you have to do is pick up the newspaper or watch TV and you see the cases of addiction, deaths and crime we are facing because of the misuse of pain medication,” said Dr. Richard Peppler, UCF’s associate dean for faculty and academic affairs, who helped lead UCF’s pledge. “We want to be leaders in medicine and this is a public health issue we need to help address.”

The school’s curriculum already addresses the dangers of prescribing opioids, but a year ago, Dr. Martin Klapheke, assistant dean for medical education and a psychiatrist by training, asked for a complete accounting of where and how often the topic was addressed in light of the national epidemic of prescription drug deaths and overdoses. Now Klapheke is leading a UCF task force to recommend, design, and implement an expanded curriculum that will begin with the new school year.

Klapheke says UCF’s goal is to provide the next generation of physicians with more evidence-based recommendations on issues such as when opioids should be prescribed and for how long, how patients should be monitored, when and how physicians should taper a patient’s dosage and how patients with previous substance abuse problems should be treated for pain. For example, the new training he is developing advises that except in instances of cancer, end-of-life or palliative care, opioids should generally only be used for short-term treatment of acute pain. The CDC guidelines indicate that three days or less is often sufficient to manage such pain and that more than seven days is not often needed Clinicians should not prescribe extra opioids “just in case” pain continues longer than expected; rather, the patient needs to be re-evaluated if pain persists.

The new instruction will also advise students to beware of providing chronic prescription of opioids for chronic non-specific pain, such as low back pain, headaches and fibromyalgia and to ensure that opioids are given only if the patient shows significant improvement in both his or her level of pain and physical function. The curriculum will also include more information on non-opioid pharmacologic treatments for pain as well as non-pharmacologic treatments, such as physical therapy and cognitive behavioral therapy.

Klapheke says physicians historically have not received a great deal of training on managing pain with prescription drugs, noting that when he attended medical school he received more information on prescribing antibiotics than on prescribing pain killers.

The medical schools that have pledged to  require their students to take some form of prescriber education, in line with the newly released Centers for Disease Control and Prevention Guideline for Prescribing Opioids for Chronic Pain include: