Increasing Naloxone Co-prescription for Patients on Chronic Opioids: a Student-Led Initiative

Freise, Jonathan; McCarthy, Elizabeth; Guy, Michelle; Steiger, Scott; Sheu, Leslie

doi:10.1007/s11606-018-4397-7

Cited by 9 publications

(10 citation statements)

References 4 publications

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“…Acting on harm reduction theory and prescribing naloxone involves a team-based approach and may represent a philosophical shift for many providers. 20 , 44 Educators at other institutions may benefit from developing harm reduction curricula using a multidisciplinary team involving faculty from multiple departments, such as internal medicine, pediatrics, and/or psychiatry, as well as engaging students and people who use opioids in curricular development. To address the lack of observed behavior change among our participants, we are designing a faculty development seminar for the faculty who precept students, and we will utilize the same survey and evaluation strategy.…”

Section: Discussionmentioning

confidence: 99%

“…18 However, medical education curricula may lack grounding in harm reduction theory and may not explicitly address naloxone distribution outside of elective experiences or specific patient groups, such as those on long-term opioid therapy for chronic pain. 19,20 Efforts have yet to incorporate mandatory curricula about harm reduction theory for medical students or integrate OEND into required clinical clerkships, and concerns have been raised about the lack of addiction training in medical schools nationally. 19,21 Given the public health crisis, it is imperative that future physicians are equipped with the knowledge and attitudes necessary to reduce risks associated with opioid use and to achieve the core competencies for addressing substance use, which emphasize harm reduction theory.…”

Section: Introductionmentioning

confidence: 99%

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Opioid Overdose Prevention Education for Medical Students: Adopting Harm Reduction into Mandatory Clerkship Curricula

et al. 2020

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Background: Opioid overdose deaths constitute a public health crisis in the United States. Strategies for reducing opioid-related harm are underutilized due in part to clinicians' low knowledge about harm reduction theory and limited preparedness to prescribe naloxone. Educational interventions are needed to improve knowledge and attitudes about, and preparedness to address, opioid overdoses among medical students. Methods: Informed by the Department of Veterans Affairs' Overdose Education and Naloxone Distribution (OEND) program and narrative medicine, we developed and led a mandatory workshop on harm reduction for clerkship medical students. Using validated scales, we assessed students' knowledge and attitudes about, and preparedness to address, opioid overdoses before the workshop and 6 weeks after. Results: Of 75 participating students from February through December 2017, 55 (73%) completed pre-workshop and 38 (51%) completed both pre-and post-workshop surveys. At baseline, 40 (73%) encountered patients with perceived at-risk opioid use in the previous 6 weeks, but only 11 (20%) recalled their teams prescribing naloxone for overdose prevention. Among those completing both surveys, knowledge about and preparedness to prevent overdose showed large improvement (Cohen's d ¼ 0.85, P < .001; Cohen's d ¼ 1.24, P < .001, respectively) and attitudes showed moderate improvement (Cohen's d ¼ 0.32, P ¼ .04). Discussion: Educational interventions grounded in harm reduction theory can increase students' knowledge and attitudes about, and preparedness to address, opioid overdoses.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Opioid Overdose Prevention Education for Medical Students: Adopting Harm Reduction into Mandatory Clerkship Curricula

et al. 2020

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“…States, healthcare systems, and clinics have adopted co‐prescribing naloxone with opioids as a safety measure with mixed results and substantial continued gaps 7‐12 . Overall co‐prescribing of naloxone in Medicare beneficiaries in 2017 was only 1.2% in Ohio, 7 where our health system is located, despite numerous efforts to address naloxone availability as a strategy to reduce deaths from the opioid epidemic.…”

Section: Introductionmentioning

confidence: 99%

A Healthcare System‐Level Intervention to Increase Naloxone Availability for Patients With Opioid Prescriptions

et al. 2020

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Background and Objectives National guidelines recommend prescribing naloxone to patients receiving chronic opioids. However, provider adherence to naloxone co‐prescribing best practices is poor and knowledge gaps for improvement efforts are large. As part of a system‐wide quality improvement intervention to improve opioid safety, we sought to improve access to naloxone for patients with opioid prescriptions. Methods A prompt for naloxone co‐prescribing was implemented in the electronic health record. Baseline data and data after implementation were collected for naloxone co‐prescribing and fill rates on naloxone prescriptions s (n = 9122 pre, 8368 post). Results In the 9 months following the implementation of the electronic prompt, the total number of naloxone prescriptions increased more than 15‐fold. Patients prescribed naloxone filled their naloxone prescriptions similarly (42%) before and after the prompt implementation, resulting in a marked increase in the absolute number of patients with access to naloxone. Patient fill rates varied by clinical area (33% emergency medicine to 47% general medicine). Conclusion and Scientific Significance An electronic prompt, encouraging providers to prescribe naloxone to at‐risk patients led to a marked increase in the percentage of patients with an active naloxone prescription. The availability of naloxone in communities saves lives and this study is the first to demonstrate an intervention, which led to increased naloxone prescribing and reported on actual pharmacy fills of naloxone when co‐prescribed with opioids. (Am J Addict 2020;00:00–00)

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“…Although initial data suggest that incorporating MOUD waiver training into UME is desired by students and increases knowledge regarding OUD treatment, 28–31 it is important to recognize this training was developed for physicians, not medical students. Most medical students believe training in these topics should occur during UME; however, with the shift in legislation allowing physicians to prescribe buprenorphine without a waiver, it is the optimal time to consider how best to incorporate training regarding MOUD into UME to ensure future physicians have sufficient knowledge to treat patients with SUD.…”

Section: Introductionmentioning

confidence: 99%

Optimizing buprenorphine training during undergraduate medical education: Medical student feedback and attitudes

et al. 2023

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Background and Objectives: Strong evidence supports efficacy of medications for opioid use disorder (MOUD), but stringent prescribing policies impair access. Many physicians report discomfort prescribing MOUD due to inadequate knowledge. Most medical students believe MOUD training should occur during undergraduate medical education (UME). As legislation surrounding buprenorphine prescribing shifts, it is timely to consider how best to incorporate MOUD training into UME. Methods: At the start of 3rd year, all students (n = 290) received a survey regarding experiences working with people with OUDs, and beliefs and knowledge regarding harm reduction and treatment. During orientation, students completed an 8-h online MOUD training. Afterwards, students completed another survey, including questions about training perceptions. Results: One-third of students (32.8%) completed MOUD training and both surveys. Before training, 60.0% had not heard of the waiver, but 82.1% endorsed interest in prescribing buprenorphine. Despite mixed feelings about training content and delivery, 79.1% believed future classes should receive it. Most thought it should be integrated longitudinally throughout the curriculum rather than as separate online training. Conclusion and Scientific Significance: Medical students want more MOUD education throughout their training; however, the 8-h online training may be lessthan-optimal. As this training is no longer required to prescribe buprenorphine, there is an opportunity to modify the content presented. There is an urgent need for physicians with the knowledge and willingness to treat patients with OUD. Introducing integrated training about MOUD should help future physicians feel confident in their knowledge to treat patients and comfortable applying for the waiver.

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Increasing Naloxone Co-prescription for Patients on Chronic Opioids: a Student-Led Initiative

Cited by 9 publications

References 4 publications

Opioid Overdose Prevention Education for Medical Students: Adopting Harm Reduction into Mandatory Clerkship Curricula

Opioid Overdose Prevention Education for Medical Students: Adopting Harm Reduction into Mandatory Clerkship Curricula

A Healthcare System‐Level Intervention to Increase Naloxone Availability for Patients With Opioid Prescriptions

Optimizing buprenorphine training during undergraduate medical education: Medical student feedback and attitudes

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