Medical Student Screening for Naloxone Eligibility in the Emergency Department: A Value-Added Role to Fight the Opioid Epidemic

Abstract

Introduction Opioid overdose education and naloxone distribution (OEND) for use by laypersons are safe and effective at preventing deaths from opioid overdose, but emergency department (ED) implementation is challenging. Curricula addressing OEND could enable students to serve in value-added roles on the clinical team, overcome challenges of naloxone distribution, and improve patient care. Methods We created a 1-hour didactic session on opioid use disorder and OEND for first-year medical students in the emergency medicine elective. During two clinical shifts, students used this knowledge to perform screenings to identify patients at high risk of overdose. If a patient screened positive, students performed patient education and then notified the physician, who ordered a naloxone kit. Results Thirty students received the didactic and conducted screening shifts. Of 147 patients screened, 40% ( n = 59) were positive for naloxone eligibility, 21% ( n = 31) reported that someone close to them used opioids, 18% ( n = 26) had witnessed an opioid overdose, 12% ( n = 17) had previously overdosed themselves, and 12% ( n = 18) previously knew what naloxone was. Fifty-nine naloxone kits were distributed over the 3-month pilot versus 13 naloxone prescriptions for patients discharged from the ED the prior year. Discussion Through didactic training and structured patient engagement, medical students gained knowledge of and hands-on experience with addiction medicine, discussed sensitive topics with patients, and identified a high volume of patients eligible to receive naloxone. Medical student screening for OEND in ED patients is feasible and adds significant value to the clinical team.

US medical school curriculum on opioid use disorder—a topic review of current curricular research and evaluation of winning student-designed opioid curricula for the 2021 Coalition on Physician Education in Substance Use Disorders curricular competition

“…Further, only 3 out of the 17 studied curricula mentioned pain in their major topic areas and the pain topic had a limited focus on managing pain in patient with OUD ( 29 , 30 , 33 ). In addition, a small number of programs focused on students' clinical skills, such as team-based practice, motivational interview and application of SBIRT (Screening, Brief Intervention, and Referral to Treatment), patient screening and education ( 34 – 36 ).…”

“…OUD curricula were delivered to medical students at various training stages during the 4-year period: year 1 (5 studies), year 2 (3 studies), year 3 (5 studies), year 4 (1 study), and mixed years (years 1–4, years 1–3, or years 3 + 4) (3 studies). Although most curricula were delivered in a non-clinical setting, 2 were in the emergency department ( 36 , 39 ) and 1 during internal medicine clerkship ( 30 ). Three studies compared the effectiveness of training using online vs. in-person programs ( 28 , 40 , 41 ).…”

“…The respond rates were much lower when longer intervals were used in the post-test. Notably, one study used reflective writing as an assessment tool after students attended patient panels ( 37 ); two studies focused on assessing learners' hands-on clinical skills (one used a simulated scenario involving an OUD case at emergency department, and one used videos involving role-playing physician-patient interactions) ( 34 , 35 ); and one study assessed patient outcomes (naloxone kit uptake) following students performing patient screening and education ( 36 ).…”

“…In addition, a small number of programs focused on students' clinical skills, such as team-based practice, motivational interview and application of SBIRT (Screening, Brief Intervention, and Referral to Treatment), patient screening and education (34)(35)(36). All programs studied were standing-alone as an addition to the respective existing medical school curricula with the reported total length ranging from 0.5-2 h (8 studies) or 8-11 h (6 studies) (3 articles did not specify the length of their programs).…”

Opioid Use Disorder Curriculum: Preclerkship Pharmacology Case-Based Learning Session

“…Other preclerkship curricula in the literature focus on various areas surrounding OUD, from opioid use in pain management 20 , 21 to opioid risk-mitigation strategies (e.g., using naloxone to treat opioid overdose). 22 MedEdPORTAL even hosts a collection of publications on opioids, addiction, and pain medicine. 23…”