A Call for Training Graduate Medical Students on Harm Reduction for People who Inject Drugs

Jawa, Raagini; Saravanan, Nivetha; Burrowes, Shana A B; Demers, Lindsay

doi:10.1080/08897077.2021.1932697

Cited by 6 publications

(6 citation statements)

References 12 publications

(15 reference statements)

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“…-In-person synchronous Naloxone demonstration No Naloxone, overdose etiology/physiology, overdose risk, overdose identification No evaluation of student learning was reported Not Available, but based on AHA Opioid Associated Life-Threatening Emergency Algorithm Jawa 2020 [ 54 ] Boston Medical Center at Boston University School of Medicine IM PGY1 (pilot) Medical and surgical PGY and fellows (expanded program) -Voluntary (expanded program) -15 min. -In-person synchronous Didactics, small group discussion, naloxone demonstration No Naloxone, Good Samaritan laws, overdose etiology/physiology, overdose identification 1) Comfort administering naloxone ( pre/post – 1 month )* 2) Comfort counseling patients on naloxone use ( pre/post – 1 month )* 3) Naloxone prescribing behavior ( pre/post – 1 month ) Fully Available in MedEd Portal Jawa 2021 [ 55 ] Boston University School of Medicine MS1, MS2, medical masters students, PA students, dental students -Voluntary -2 hr. -In-person synchronous Didactics, naloxone demonstration, local organizations Yes Overdose prevention, naloxone, safer injection, SSPs, overdose etiology/physiology, overdose risk, overdose identification, MOUD, infectious complications 1) Comfort with harm reduction ideology ( pre/post )* 2) Knowledge on safe injection technique ( pre/post )* 3) Comfort and knowledge on administering naloxone ( pre/post )* Not Available Klapheke 2017 [ 56 ] University of Central Florida College of Medicine MS3 psychiatry clerkship -Mandatory -30-50 min.…”

Section: Resultsmentioning

confidence: 99%

Harm reduction in undergraduate and graduate medical education: a systematic scoping review

Smith,

Shah,

Adamczyk

et al. 2023

BMC Med Educ

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Background Substance use increasingly contributes to early morbidity and mortality, which necessitates greater preparation of the healthcare workforce to mitigate its harm. The purpose of this systematic scoping review is to: 1) review published curricula on harm reduction for substance use implemented by undergraduate (UME) and graduate medical education (GME) in the United States and Canada, 2) develop a framework to describe a comprehensive approach to harm reduction medical education, and 3) propose additional content topics for future consideration. Methods PubMed, Scopus, ERIC: Education Resources Information Center (Ovid), and MedEdPORTAL were searched. Studies included any English language curricula about harm reduction within UME or GME in the United States or Canada from 1993 until Nov 22, 2021. Two authors independently reviewed and screened records for data extraction. Data were analyzed on trainee population, curricula objectives, format, content, and evaluation. Results Twenty-three articles describing 19 distinct educational programs across the United States were included in the final sample, most of which created their own curricula (n = 17). Data on educational content were categorized by content and approach. Most programs (85%) focused on introductory substance use knowledge and skills without an understanding of harm reduction principles. Based on our synthesis of the educational content in these curricula, we iteratively developed a Harm Reduction Educational Spectrum (HRES) framework to describe curricula and identified 17 discrete content topics grouped into 6 themes based on their reliance on harm reduction principles. Conclusions Harm reduction is under-represented in published medical curricula. Because the drug supply market changes rapidly, the content of medical curricula may be quickly outmoded thus curricula that include foundational knowledge of harm reduction principles may be more enduring. Students should be grounded in harm reduction principles to develop the advanced skills necessary to reduce the physical harm associated with drugs while still simultaneously recognizing the possibility of patients’ ongoing substance use. We present the Harm Reduction Educational Spectrum as a new framework to guide future healthcare workforce development and to ultimately provide the highest-quality care for patients who use drugs.

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Section: Resultsmentioning

confidence: 99%

Harm reduction in undergraduate and graduate medical education: a systematic scoping review

Smith,

Shah,

Adamczyk

et al. 2023

BMC Med Educ

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“…Given known barriers of healthcare-related stigma [ 32 , 33 ] and lack of standardized medical education on harm reduction practices [ 34 ], we found that coupling clinician and staff training with on-site kit distribution facilitated the adoption of our intervention as a new clinic standard of care. We used multiple implementation strategies to communicate a shared vision to change our clinic culture to embrace a patient-centered approach to care grounded in the principles of relational harm reduction [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

Implementing harm reduction kits in an office-based addiction treatment program

Shang,

Thiel,

Liebschutz

et al. 2023

Harm Reduct J

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Background The rising rates of drug use-related complications call for a paradigm shift in the care for people who use drugs. While addiction treatment and harm reduction have historically been siloed in the US, co-location of these services in office-based addiction treatment (OBAT) settings offers a more realistic and patient-centered approach. We describe a quality improvement program on integrating harm reduction kits into an urban OBAT clinic. Methods After engaging appropriate stakeholders and delivering clinician and staff trainings on safer use best practices, we developed a clinical workflow for universal offering and distribution of pre-packaged kits coupled with patient-facing educational handouts. We assessed: (1) kit uptake with kit number and types distributed; and (2) implementation outcomes of feasibility, acceptability, appropriateness, and patient perceptions. Results One-month post-implementation, 28% (40/141) of completed in-person visits had at least one kit request, and a total of 121 kits were distributed. Staff and clinicians found the program to be highly feasible, acceptable, and appropriate, and patient perceptions were positive. Conclusions Incorporating kits in OBAT settings is an important step toward increasing patient access and utilization of life-saving services. Our program uncovered a significant unmet need among our patients, suggesting that kit integration within addiction treatment can improve the standard of care for people who use drugs.

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“…Beyond core curricular integration, we also invite students to complete the form via HMS distribution listservs and at the end of a voluntary extracurricular event that educates attendees on harm reduction techniques, including the use of naloxone [ 13 ].…”

Section: Methodsmentioning

confidence: 99%

Systemized approach to equipping medical students with naloxone: a student-driven initiative to combat the opioid crisis

Saberi,

Moore,

et al. 2024

BMC Med Educ

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Background Naloxone is an effective and safe opioid reversal medication now approved by the U.S. Food and Drug Administration (FDA) for use with or without a prescription. Despite this, naloxone dissemination lags at a time when U.S. opioid-related mortality expands. The authors proposed distributing naloxone to all U.S. medical students using established statewide standing prescription orders for naloxone, eliminating the financial burden of over-the-counter costs on students and streamlining workflow for the pharmacy. By focusing naloxone distribution on medical students, we are able to capitalize on a group that is already primed on healthcare intervention, while also working to combat stigma in the emerging physician workforce. Methods Beginning August 2022, the authors established a partnership between Harvard Medical School (HMS) and the outpatient pharmacy at Brigham and Women’s Hospital (BWH) to facilitate access to naloxone for HMS medical students. BWH developed a HIPAA-secure electronic form to collect individual prescription information. BWH pharmacists processed submissions daily, integrating the naloxone prescription requests into their workflow for in-person pick-up or mail-order delivery. The electronic form was disseminated to medical students through a required longitudinal addiction medicine curriculum, listserv messaging, and an extracurricular harm reduction workshop. Results Over the 2022–2023 academic year, 63 medical students obtained naloxone kits (two doses per kit) through this collaboration. Conclusions We propose that medical schools advocate for a hospital pharmacy-initiated workflow focused on convenience and accessibility to expand naloxone access to medical students as a strategy to strengthen the U.S. emergency response and prevention efforts aimed at reducing opioid-related morbidity and mortality. Expansion of our program to BWH internal medicine residents increased our distribution to over 110 healthcare workers, and efforts to expand the program to other BWH training programs and clinical sites such as the emergency department and outpatient infectious disease clinics are underway. With more than 90,000 medical students in the U.S., we believe that widespread implementation of targeted naloxone training and distribution to this population is an accessible approach to combating the public health crisis of opioid-related overdoses.

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A Call for Training Graduate Medical Students on Harm Reduction for People who Inject Drugs

Cited by 6 publications

References 12 publications

Harm reduction in undergraduate and graduate medical education: a systematic scoping review

Harm reduction in undergraduate and graduate medical education: a systematic scoping review

Implementing harm reduction kits in an office-based addiction treatment program

Systemized approach to equipping medical students with naloxone: a student-driven initiative to combat the opioid crisis

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