- College of Medicine
The College of Medicine is one of 60 medical schools across the country recognized this week by the White House for pledging to teach medical students about the dangers of prescribing opioids to patients for pain. The pledge comes as President Obama announced additional public-private efforts to fight the nation’s epidemic of prescription opioid and heroin abuse, which are killing tens of thousands of Americans a year.
UCF joins medical schools like Tulane, Tennessee, Ohio State, Rutgers, Louisville, Wisconsin and Baylor, that will require medical students to get increased training in prescribing such pain medications before they graduate. UCF will begin the expanded curriculum – which was unanimously approved by the college’s curriculum committee – in the fall.
“All you have to do is pick up the newspaper or watch TV and you see the cases of addiction, deaths and crime we are facing because of the misuse of pain medication,” said Dr. Richard Peppler, associate dean for faculty and academic affairs, who helped lead UCF’s pledge. We want to be leaders in medicine and this is a public health issue we need to help address.”
The prescriptive use of opioids has direct ties to the nation’s burgeoning heroin epidemic, as the Centers for Disease Control and Prevention (CDC) report that three of four people using heroin began with prescription opioids, making such prescriptions gateway drugs to the highly addictive street narcotic.
The medical school’s integrated curriculum already includes longitudinal themes like patient safety, ethics and health disparities, which are woven throughout all four years of education. The dangers of prescribing opioids are already addressed in the curriculum. However, a year ago, Dr. Martin Klapheke, assistant dean for medical education and a psychiatrist by training, asked for a complete accounting of where and how often the topic was addressed in light of the national epidemic of prescription drug deaths and overdoses. And the pledge effort for medical schools provided more opportunity to tighten up the curriculum with even more content.
Dr. Klapheke is leading a UCF task force to recommend, design, and implement an expanded curriculum that will begin with the new school year. In some of these sessions, students will apply what they know to real cases. The pledge says participating medical schools will include in their expanded curriculums new guidelines from the CDC for use of prescription opioids.
Dr. Klapheke said UCF’s goal is to provide the next generation of physicians with more evidence-based recommendations on issues such as when opioids should be prescribed and for how long, how patients should be monitored, when and how physicians should taper a patient’s dosage and how patients with previous substance abuse problems should be treated for pain. For example, the new training he is developing advises that except in instances of cancer, end-of-life or palliative care, opioids should generally only be used for short-term treatment of acute pain. The CDC guidelines indicate that three days or less is often sufficient to manage such pain and that more than seven days is not often needed Clinicians should not prescribe extra opioids “just in case” pain continues longer than expected; rather, the patient needs to be re-evaluated if pain persists.
The new instruction will also advise students to beware of providing chronic prescription of opioids for chronic non-specific pain, such as low back pain, headaches and fibromyalgia and to ensure that opioids are given only if the patient shows significant improvement in BOTH his or her level of pain and physical function. The curriculum will also include more information on non-opioid pharmacologic treatments for pain as well as non-pharmacologic treatments, such as physical therapy and cognitive behavioral therapy.
Dr. Klapheke said physicians historically have not received a great deal of training on managing pain with prescription drugs, noting that when he attended medical school he received more information on prescribing antibiotics than on prescribing pain killers.
“We needed to make a commitment, a statement, to increase awareness,” he said. “Opioid addiction has been devastating to so many patients and their families across the United States.”