- College of Medicine Faculty News Medical UCF
A UCF College of Medicine assistant dean, who is leading efforts to educate medical students about the dangers of prescribing opioids for chronic pain, has been invited to Washington to share the school’s expanded curriculum on the dangers of the highly addictive drugs.
Dr. Martin Klapheke, assistant dean for medical education and professor of psychiatry, is leading UCF’s efforts and working to share them with medical schools across the state and nation. Last March, UCF was one of 60 medical schools in the nation – and the only in Florida – that pledged to teach medical students about the dangers of prescribing opioids throughout their four years of training in an effort to curb the growing epidemic of prescription opioid and heroin abuse.
On Wednesday, Dec. 7, the U.S. Department of Health and Human Services will host a group including physicians and medical educators at the White House to discuss plans for developing new strategies for dealing with the opioid crisis and identifying ways the healthcare community can collaborate to find more effective solutions.
Klapheke will share UCF’s expanded curriculum. It includes opioid training in subjects from psychiatry to pediatrics, where physicians are seeing an increase in the number of opioid-addicted newborns whose mothers used the pain medication during pregnancy. Neurology includes a mandatory module on when and when not to use opioids for headaches, back pain and diabetic neuropathy.
A new module, taught by Klapheke and Family Medicine specialist, Dr. Magdalena Pasarica, requires students to devise a treatment plan for a typical case that could, without attention to risk-mitigation strategies, lead to addiction: A patient comes to the doctor in acute pain from an injury, is prescribed opioids for a short time and then returns to the doctor weeks and months later still complaining of pain and seeking more of the drug. In the module, students work in teams to discuss whether to prescribe opioids, for how long, how to implement follow-up safeguards, identify patients who may be in danger of addiction and identify non-narcotic treatments for pain.
“Our students have a unique opportunity – and a duty – to help address this public health crisis,” Klapheke said. “We need to address this issue in medical schools, residencies and continuing medical education for practicing physicians. Everything we do has to raise awareness because people are dying.”
Opioid and heroin overdoses killed more than 28,000 people in America in 2014, according to the American Society of Addiction Medicine. The Centers for Disease Control reports that that 75 percent of heroin users became addicted to the street drug after being prescribed opioids. The CDC says more than 50 percent of those prescriptions came from primary care physicians who prescribed opioids for conditions including back pain, chronic headaches and arthritis symptoms.
The latest CDC guidelines that the UCF College of Medicine teaches say opioids generally should only be used for acute pain and usually for less than a week and that physicians should have detailed treatment plans when they prescribe opioids, including follow-up urine screens and determinations of whether the medication is actually improving the patient’s functioning, not just reducing pain.
While the CDC acknowledges that opioids have a place in cancer and end-of-life pain relief, it is urging physicians to not use the highly addictive drugs for chronic pain unless there are clear improvements in both symptoms and function and if there are no reasonable alternatives.
The stance is a new approach, after physicians had been urged to keep their patients pain-free and received heavy marketing from drug companies on the benefits of opioids, including claims that they were not addictive. Klapheke noted that when he attended medical school, he received more information on prescribing antibiotics than on prescribing pain pills.
Other physician leaders agree. “It is important to recognize that we arrived at this place on a path paved with good intentions,” U.S. Surgeon General Dr. Vivek Murthy wrote recently to 2.3 million U.S. physicians and healthcare providers. “Nearly two decades ago we were encouraged to be more aggressive about treating pain, often without enough training and support to do so safely…The results have been devastating. Since 1999 opioid overdose deaths have quadrupled and opioid prescriptions have increased markedly, almost enough for every adult in America to have a bottle of pills.”