Apr 24, 2019
Host Lorenzo Norris, MD,
returns this week for a dual-specialty episode on the opioid crisis
and how it can be mitigated. He welcomes psychiatrist Martin Klapheke, MD, and family
practice physician Magdelena
Pasarica, MD, PhD, to talk about education, strategies, and
collaboration between psychiatry and family practice medicine.
In Dr. RK this week, Renee Kohanski, MD, talks about whether
something is indeed better than nothing.
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By Jacqueline Posada, MD, 4th-year resident in the department of
psychiatry & behavioral sciences at George Washington
M. Klapheke: psychiatry residency program director; assistant
dean, medical education; and professor of psychiatry at University
of Central Florida, Orlando
Magdalena Pasarica: associate professor of medicine; medical
director, KNIGHTS (Keeping Neighbors in Good Health Through
Service) student-run free clinic; family medicine chair, Family
Medicine Interest Group adviser at University of Central Florida,
How to address the opioid crisis during
- The opioid crisis looms large over the medical field:
- 130 deaths from opioid overdoses per day.
- 11 million people misuse opiate prescriptions and 2.1 million
people have an opioid use disorder.
- In 2018, the Department of Health & Human Services released
a 5-point strategy in response to the opioid crisis:
- Access: Providing better prevention,
treatment, and recovery services.
- Data: Offering timelier, more specific public
health data and reporting.
- Pain management: Mitigating risk while
prescribing with healthy, evidence-based methods of pain
- Overdoses: Targeting overdose-reversing drugs
- Research: Doing better research on pain and
Educating the next generation of medical professionals
to address the opioid crisis
- From the family medicine and resident education point of view:
- Mitigate the risk when prescribing opiates.
- Identify opioid use disorder (OUD).
- Use the interdisciplinary approach to know when to refer to
psychiatry and pain medicine.
- Primary care providers are on the front lines of the crisis, as
11% of patients report chronic pain.
- PCP will have to treat pain and:
- From the psychiatric and medical education point of view:
- Before opioid crisis, there was little instruction in how to
treat acute or chronic pain.
- Medical education now teaches about pain management:
Information about non-narcotic analgesics, nonmedication pain
treatments, and addiction and its treatment.
- Medical students: Focus on working with family members of those
with OUD and especially on using naloxone to reverse opioid
Interprofessional approach is most effective with
communication with shared priorities
We can collaborate effectively by understanding our shared
priorities and offering all providers the opportunity to working
toward these priorities in their own ways.
From Dr. Klapheke: The opioid crisis crosses
all specialties of medicine, and doctors will reach the limit of
- Work interprofessionally by communicating and knowing what
resources are available.
- Communicate what each party is doing for the epidemic and for
- This means knowing about resources in the hospital, clinics,
city, county, law enforcement, etc.
From Dr. Pasarica:
Again, we must acknowledge the limits of our expertise and work
interdisciplinarily in a team-based approach.
- Each team member needs to be responsible for the follow-up,
even if the patient is referred to another person such as a
counselor or a psychiatrist.
- Each team member must share information and what has been done
for the patient.
How is addressing the opioid epidemic being integrated
into medical student and resident education?
Klapheke: At University of
Central Florida, the medical school uses vertical and horizontal
integration of information into the curriculum.
- During the preclinical years: Write OUD and pain management
into standardized patient work.
- Focus on the pharmacology of opiates and understanding
neuroscience of addiction.
- During clinical rotations: Discuss OUD and the opioid epidemic
during every specialty rotation and in lectures:
- Use simulations: For example, during the third year, treat a
patient experiencing opioid overdose.
- Medical schools should take advantage of already created online
resources to teach about substance use disorder and opioid use
- Educating medical students and residents to incorporate family
members in treatment:
- Give family members information on chronic pain, addiction, and
refer them to support groups.
From Dr. Pasarica: There also is a focus on
interdisciplinary care in clerkships and in the student-run free
clinic. It is important to teach interdisciplinary care in
clerkships and volunteer settings.
- Work with counseling students and pharmacy students to screen
and manage substance use disorder.
- Visit treatment and recovery sites during medical school to see
interdisciplinary work in action.
General ways to teach about the opioid epidemic in
- Focus on longitudinal educational experiences about pain and
- Focus on interdisciplinary care.
- Talk about pain in all different settings.
- Create simulations and online training modules.
- Use the medical school and GME network: Collaborate with other
medical schools and hospitals about education and treatment.
- Address the stigma that occurs in the health care setting:
- Stigma is a barrier to patients and family accessing
- Nonjudgmental education about opioids, the crisis, and
treatment can decrease stigma from health care providers.
Department of Health & Human Services:
5-point Strategy to Combat the Opioid Crisis
Association of American Medical Colleges
News: “Responding to the opioid epidemic through education,
patient care, and research.”