The UMass Medical School Opioid Conscious Curriculum

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1 Responding to the Opioid Crisis in Massachusetts The UMass Medical School Opioid Conscious Curriculum AAMC Government Relations Representatives James Leary, JD Vice Chancellor for Government & Community Relations June 8, 2016 OSTI Opioid Safe-prescribing Training Immersion Opioid Conscious Curriculum

2 The Timeline 1. Emergence of the crisis and Governor s call to action 2. Role of Massachusetts medical schools generally and UMass Medical School in particular 3. The road ahead

3 Emergence of a Public Health Crisis Dramatic Spike in Suspected Opioid-Related Incidents Across Massachusetts 2013: 6,315 incidents 2014: 9,594 incidents 2015: 11,884 incidents Source: Massachusetts Department of Public Health,

4 Emergence of a Public Health Crisis Massachusetts DPH Data on Opioid Related Deaths

5 Governor s Call to Action Governor s Medical Education Working Group on Prescription Drug Misuse 25 Members from the 4 MA Medical Schools and Medical Society

6 Agreement by MA Medical Schools, Dept. of Public Health and Medical Society November 9, 2015

7 Agreement: 10 Core Competencies for All Graduating Medical Students Preventing Prescription Drug Misuse 1. Evaluating Pain 2. Evaluating Risk for Substance Use Disorders (SUD) 3. Identifying Treatment Options Treating Patients At-Risk for Substance Use Disorders 4. Describe treatments including medication-assisted treatment 5. Prepare pain management and SUD treatment plans 6. Foundational skills in counseling and behavior change Managing Substance Use Disorder as a Chronic Disease 7. Recognize signs of overdose and use of Narcan rescue 8. Apply chronic disease model to SUD 9. Recognize one s own stigma and bias 10. Incorporate data regarding social determinants of health

8 When???... Now! Medical schools to bolster opioid lessons By Felice J. Freyer Globe Staff November 09, 2015 What we re seeing in the community suggests that there s a problem in how many opiate doses are out there, said Dr. Terence R. Flotte, dean of the UMass medical school. Whatever we re doing now is not good enough.

9 November 2015: UMMS s Actions to Immediately Implement 10 Core Competencies UMMS commits that every graduating MD and Advanced Practice Nursing student and every new Resident will be trained in 10 core competencies Academic leadership begins designing new Opioid Conscious Curriculum Spring 2016: Mandatory training of every MD and APN about to graduate and all 2 nd Year MD students Summer 2016: Mandatory training of every incoming Resident

10 Spring & Summer 2016 Training The OSTI Opioid and Safe Prescribing Training Immersion Addresses all 10 Core Competencies & 3 Domains Agreed to by the 4 MA Med Schools, MMS and Mass DPH: Preventing prescription drug misuse; Treating patients at risk for SUD; Managind SUD as a chronic disease Realistic, Hands-on, Skills-based Training & Instruction 5 intensive encounters with patient actors ( Standardized Patients ) Sessions with SUD patients in recovery and their families Hands-on overdose care and naloxone rescue Reflective writing

11 Unique Aspects of OSTI Inter-professional: medical and nursing students train side by side Simulation-based scenarios have look and feel of real patient care setting Challenging skills are practiced, observed and assessed Students meet with real patients in recovery and their families Stigma, bias and barriers to treatment are addressed Robust evaluation and reflection

12 Sample Training Scenarios ORTHOPEDIC CLINIC PRIMARY CARE EMERGENCY ROOM Acute traumatic pain in patient with a fractured arm who requires opioid pain management Chronic low back pain in a long-term patient on opioids with signs of aberrant behavior, requiring opioid safeguards Patient with overdose and relapse from recovery, who requires naloxone rescue and referral for substance abuse treatment

13 The Road Ahead Faculty / Academic Leadership: Comprehensive evaluation of OSTI with data analysis, research and scholarship Assess, develop and improve opioid education across broad curriculum Students: Inter-professional education across all 3 schools (Med, Nursing, Biomedical Science) Enrichment electives, such as Substance Abuse from Patients' Perspective, Adolescent Substance Abuse, Addiction Medicine Membership on Mass Medical Society Opioid Prescribing Task Force Engagement in research: Narcan, local treatment programs, and addiction curriculum Community: Continue existing community collaborations e.g., City of Worcester DPH, Community Health Improvement Plan, Worcester County DA s Opioid Task Force, etc.

14 FOR A HEALTHIER WEST VIRGINIA GOING ABOVE AND BEYOND

15 THE RISING TIDE OF ADDICTION WV has the highest rate of prescription drug and heroin overdose deaths in the nation among 12- to 25-year olds. There were 33.5 drug overdose deaths per 100,000 WV residents from ; More than double the national average of 13.4 deaths per 100,000 people. 1 in 5 babies in WV is born addicted. Painkillers now kill more Americans than any other illegal drug.

16 CONTRIBUTING FACTORS Economic instability resulting in lack of employment opportunities for laborers and trade workers. History of on-the-job injuries and chronic disease from dangerous occupations such as coalmining, oil and gas. Impoverished region's history of poor education. Isolation of people and communities in rugged mountainous terrain. Limited offering of substance abuse programs, though it's growing, but services may be far away and hard to reach.

17 WHAT THE STATE IS DOING Authorities have cracked down on doctors who run pill mills. Two state agencies have an ongoing lawsuit seeking to unseal court records about drug shipments from 11 pharmaceutical distributors. Working to reinstate a national program where people can turn in expired and unwanted prescription pills to police agencies on designated days. Reclassifying certain prescription drugs to limit the amount and frequency that can be dispensed without a person being rechecked by a physician.

18 WHAT WEST VIRGINIA UNIVERSITY IS DOING Reforming patient care Treating people on campus and across the state with latest telemedicine technology; Improving screening techniques to identify chronic abusers earlier; Expanding tailored medication/therapy programs. Empowering our allies Collaborating and partnering with allies throughout the state to empower West Virginians to improve the health of their own communities. Training the next generation Training the next generation of healthcare providers; continual expansion of health sciences curricula to include more education on addiction. Real research for real solutions Increasing the funding for practice-based research and collaborating with academic partners on finding real solutions.

19 REFORMING PATIENT CARE Telepsychiatry Addiction Services COAT-Comprehensive Opioid Addiction Treatment Personalized Medicine Initiative Drug-Free Moms and Babies Project Harm Reduction

20 EMPOWERING OUR ALLIES Law Enforcement Naloxone Program WVU Collegiate Recovery Program Rational Drug Therapy Program (RDTP) Opioid Medication Therapy Management Program (O-MTM) School of Pharmacy s Introductory Pharmacy Practice Experience (IPPE)

21 TRAINING THE NEXT GENERATION At WVU, all first- and second-year medical students are exposed to courses that specifically address addiction. Medical students spend two weeks on clinical rotations devoted to treating addiction patients. Both WV medical schools, WVU and Marshall University, support the commitment requested by President Barack Obama to educate future doctors on new CDC opiate prescription guidelines. WVU offers courses, also online, to physicians and other providers aimed at reducing opioid use and to help meet the state s drug diversion education requirements. WVU offers internship experiences for social work and counseling students.

22 REAL RESEARCH FOR REAL SOLUTIONS WVU and Marshall University have each committed $750K toward collaborative programs aimed at finding solutions for West Virginians. Practice-Based Research Network (PBRN) researchers collaborate with health professionals to study substance abuse prevention and treatment programs.

23 POLICY DISCUSSION ITEMS Expectations regarding long term treatment (chronic condition) Wait lists for treatment Success rate expectations

24 WEST VIRGINIA DESERVES A HEALTHIER FUTURE

25 Responding to the Opioid Epidemic June 8, 2016 D. Michael Carroll Asst. Vice President for Governmental Relations

26 Responding to the Opioid Epidemic Public Health Issue Law Enforcement Issue Jobs Issue

27 Responding to the Opioid Epidemic SOLACE Surviving Our Loss And Continuing Every day 2012 Governor s Courage Award

28 Responding to the Opioid Epidemic 129 th General Assembly Two bills 130 th General Assembly 17 bills 131 st General Assembly 12 bills Governor s Mid-Biennium Review (MBR)

29 Responding to the Opioid Epidemic Needle Exchanges House Bill 92 (Antonio, Sears) Prevent spread of blood-borne pathogen Passed House Died in Senate

30 Responding to the Opioid Epidemic Needle Exchanges House Bill 92 (Antonio, Sears) Prevent spread of blood-borne pathogen Passed House Died in Senate Enacted as part of HB 64 (131 st GA budget)

31 Responding to the Opioid Epidemic Needle Exchanges

32 Responding to the Opioid Epidemic Needle Exchanges Judith Feinberg, MD Founded Cincinnati Exchange Project Foundations Existing UC grant Mobile van

33 Responding to the Opioid Epidemic Needle Exchanges Four sites 5 th in autumn 2016 Supplies Screening Referrals TREATMENT

34

35 Responding to the Opioid Epidemic Challenges Defining our role Government Academic medicine Public health

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