New Physician Training Method May Help Prevent Opioid Addiction

New Physician Training Method May Help Prevent Opioid Addiction

Conventional medical practice generally holds that bringing up the subject of dependence and addiction can alienate patients - especially those already dependent and needing more pills. In fact, many doctors, if not most, tend to refill such patients' opioid painkiller prescriptions to avoid complications and confrontations that could arise by bringing up the subject of addiction and the need for additional treatment or care. A new physician training program piloted recently at California's Stanford School of Medicine may help turn this situation around. The program teaches doctors how to prescribe opioid painkillers more safely. But it also shows that opioid-dependent patients actually appreciate a doctor who is more forthright and direct about the dangers of dependence and addiction and who takes a proactive approach to the patient's need for more treatment. Stanford's "immersive" pilot program takes place in a simulated outpatient pain clinic where actors play the role of patients wanting an opioid prescription refill, but who already meet the criteria for opioid use disorder. The patients arrive with only one tablet of hydromorphone left in their prescription, and ask for a refill to prevent withdrawal. The trainees were graduate level specialists in pain medicine and/or anesthesiology. "In this immersive experience, faculty video-records the trainees' ability to determine the appropriate opioid-related diagnosis and risk stratification, to discuss the risk and benefits of providing an opioid, and the safety of their therapy plan," said study author Dr. Jordan L. Newmark, associate division chief for education, and pain medicine associate program director at the Stanford medical school.

Path of least resistance

"The path of least resistance would be to provide a refill per the patient's request without addressing the opioid use disorder," Dr. Newmark added. "However, the trainees who verbalized to the patient their concerns about the opioid use disorder, and asked the patient to see an addiction medicine specialist for co-management, were rated as having the highest clinical skills and satisfactory interactions with the patient. I would have expected the opposite, that honoring the patient's request for more opioids would have made them perceive the trainee in a better light." Steven Passik, PhD, vice president of scientific affairs, education and policy at Collegium Pharmaceuticals, lauded the program because it "help(s) develop skills in younger physicians early in their careers with the complex diagnostic, cognitive and communication aspects of opioid risk management. [The training program] is experiential, in concert with principles of adult learning and allows physicians to develop skills in a situation without actual consequences for a real person. It shows how even a very apparently simple request for a refill or an increase requires a complex thought process, the development of a differential diagnosis about what is driving the request, and then learning how to use resources and skills to proceed safely." Dr. Passik went on to say that "all health care providers need more training of this nature" to help physicians better appreciate the complexity of such prescribing situations. Training like this could help the health care system "recognize how much thought and effort goes into the proper management of these situations, and adequately reimburse practitioners." The study results were presented at the recent annual meeting of the American Academy of Pain Medicine.

At Novus, we applaud the concept of more education for doctors and this practice seems an excellent way to further their experiential learning.

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