Amid the statewide and nationwide opioid epidemic, the Alpert Medical School is shaping its curriculum to prepare students to treat opioid misuse disorder. Recently, it worked with the Rhode Island Department of Health to guarantee its graduates the ability to prescribe buprenorphine and medications that contain it, including Suboxone, which are used to treat opioid dependence.
Around 30 students in the Med School’s class of 2018 participated in the approved curriculum, and the curriculum is being taught to all students in the class of 2019, said Paul George, assistant dean of medical education.
Compared to medication-assisted therapy that involves methadone, which requires treatment in a clinic, “suboxone is less regimented,” said Aaron Shapiro MD ’19. “You go to a pharmacy to fill your prescription, and you take it like you would take other medications. But it has the same kind of effect (as methadone),” he added.
But most doctors cannot prescribe medications containing buprenorphine. Under the Drug Addiction Treatment Act of 2000, doctors may only prescribe buprenorphine after completing an eight-hour training course that usually requires a cost of around $200 to $400 to receive a DATA waiver, George said. Spending eight hours away from work presents a significant barrier to practicing physicians, said Rachel Ellenbogen ’11 MD ’18.
In response to these issues, the Med School sought to prepare all students to treat opioid misuse disorders before graduation and developed a “robust curriculum around pain management,” George said. The curriculum, which is 23 hours long over the course of four years, covers the physiology of pain, pain management, the pharmacology of opioids and field work involving opioids. The Med School’s curriculum approaches opioid misuse in a way that is “longitudinal and in many ways more comprehensive” than the typical eight-hour training, he added.
Alpert Medical School successfully received the DATA waiver training by applying to the Rhode Island Department of Health’s program. It is “the first school in the country that has had its curriculum approved by a state medical board,” as sufficient to warrant a DATA waiver, said James McDonald, chief administrative officer of the Rhode Island Board of Medical Licensure and Discipline.
“It’s really great that we have the exposure to treating addiction in medical school. … It exposes a lot of people who maybe wouldn’t think about treating addiction or addiction as a medical issue to thinking about what you can do as a physician to help your patients with addiction,” added Ellenbogen, who went through the curriculum.
For now, Med School graduates are only licensed to prescribe buprenorphine in Rhode Island. But George said that the Med School has been in conversation with other state health departments about establishing reciprocity for DATA waivers. The Department of Health would work with other states to show the process doctors at the Med School go through to get DATA waivers if requested, McDonald said.
As the nation comes to terms with the opioid epidemic, approaches to treatment are changing on both a legal and social level. The Substance Abuse and Mental Health Services Administration, which administers DATA waivers, recently raised the maximum number of patients to which a doctor with a DATA waiver can prescribe buprenorphine to 275 after at least two years with the waiver.
Attitudes about opioid misuse disorder are also changing as programs like the one at the Med School approach this disorder as they would treat any chronic illness, McDonald said. “How physicians look at pain, even though pain is subjective, is important. And how physicians and the patient look at people who suffer from substance misuse disorder is important, too,” he added. McDonald noted that stigma surrounding substance misuse disorder, like the label “junkie,” is unproductive. “People who suffer from a chronic disease really need help,” he said. What helps “people who are suffering from (substance misuse disorder) is getting medication-assisted treatment and getting into recovery.”
