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Models of Resident Physician Training in Opioid Use Disorders

  • Opioids (J Donroe and D Fiellin, Section Editors)
  • Published:
Current Addiction Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Medications for addiction treatment (MAT) are the standard of care for treating opioid use disorder (OUD) and reducing overdose deaths, yet demand for MAT providers has outstripped supply in the USA. Public policy and graduate medical education (GME) leaders have called for increased focus on addiction medicine training for resident physicians to mitigate this provider gap. We sought to characterize the current state of OUD training at the GME level by reviewing published literature on GME educational interventions designed to enhance the care of patients with OUD.

Recent Findings

We identified 31 articles describing 29 unique interventions. The majority of these articles detailed specific, reproducible interventions with outcomes, and tended to focus on training resident physicians in behavioral approaches to treat OUD, rather than MAT. Fewer than half of interventions involved direct patient care.

Summary

MAT training is under-represented within the current landscape of educational interventions, despite MAT being the standard of care for OUD.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Scholl L, Seth P, Kariisa M, Wilson N, Baldwin G. Drug and opioid-involved overdose deaths — United States, 2013–2017. Morb Mortal Wkly Rep. 2019;67:1419–27.

    Google Scholar 

  2. Prevention C for DC and. 2018 Annual Surveillance Report of Drug-Related Risks and Outcomes - United States 2018.

  3. • Sordo L, Barrio G, Bravo MJ, Indave BI, Degenhardt L, Wiessing L, et al. Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studies. BMJ. 2017;357. This systematic review and meta-analysis compares all-cause and overdose mortality among patients with OUD in and out of treatment with methadone or buprenorphine. Significant decreases in all-cause and overdose mortality are seen among patients on methadone maintenance, and a trend toward significance is seen among patients receiving buprenorphine.

  4. • Larochelle MR, Bernson D, Land T, Stopka TJ, Wang N, Xuan Z, et al. Medication for opioid use disorder after nonfatal opioid overdose and association with mortality: a cohort study. Ann Intern Med. 2018;169(3). This retrospective cohort study shows that engagement in treatment for OUD with methadone or buprenorphine is associated with decreased all-cause and opioid-related mortality among individuals with a previous nonfatal opioid overdose.

  5. Volkow ND, Collins FS. The role of science in addressing the opioid crisis. N Engl J Med. 2017;377(4):391–4.

    Article  PubMed  Google Scholar 

  6. Jones CM, Campopiano M, Baldwin G, Mccance-katz E. National and state treatment need and capacity for opioid agonist medication-assisted treatment. Am J Public Health. 2015;105(8):55–63.

    Article  Google Scholar 

  7. Dove HW. Postgraduate education and training in addiction disorders: defining core competencies. Psychiatr Clin N Am. 1999;22(2):481–8.

    Article  CAS  Google Scholar 

  8. Jackson AH, Alford DP, Dubé CE, Saitz R. Internal medicine residency training for unhealthy alcohol and other drug use: recommendations for curriculum design. BMC Med Educ. 2010;10(22).

  9. Ayu AP, El-Guebaly N, Schellekens A, De Jong C, Welle-Strand G, Small W, et al. Core addiction medicine competencies for doctors: an international consultation on training. Subst Abus. 2017;38(4):483–7.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Fiellin DA, Butler R, D’Onofrio G, Brown RL, O’Connor PG. The physician’s role in caring for patients with substance use disorders: implications for medical education and training. Subst Abus. 2002;23(3)(suppl):207–12.

    Article  Google Scholar 

  11. • Tesema L, Marshall J, Hathaway R, Pham C, Clarke C, Bergeron G, et al. Training in office-based opioid treatment with buprenorphine in US residency programs: a national survey of residency program directors. Subst Abus Taylor & Francis; 2018;1–7. This national survey of residency program directors in internal medicine, family medicine, and psychiatry found that 76.9% of respondents reported that their residents frequently manage patients with OUD, but that only 23.5% report that their program devotes 12 or more hours of curricular time to addiction medicine and 35.9% encourage training in OBOT.

  12. Fleming MF, Manwell LB, Kraus M, Isaacson HJ, Kahn R, Stauffacher EA. Who teaches residents about the prevention and treatment of substance use disorders? A national survey. J Fam Pract. 1999;48(9):725–9.

    CAS  PubMed  Google Scholar 

  13. • Suzuki J, Ellison TV, Connery HS, Surber C, Renner JA. Training in buprenorphine and office-based opioid treatment: A survey of psychiatry residency training programs. Acad Psychiatry. 2016;40(3):498–502. This national survey of psychiatry residency program directors found that 75.6% of responding programs currently offered buprenorphine waiver training and 78.1% provide opportunities for residents to treat OUD under supervision.

    Article  PubMed  Google Scholar 

  14. Wakeman SE, Baggett MV, Pham-Kanter G, Campbell EG. Internal medicine residents training in substance use disorders: a survey of the quality of instruction and residents self-perceived preparedness to diagnose and treat addiction. Subst Abus. 2013;34(4):363–70.

    Article  PubMed  Google Scholar 

  15. Kunins HV, Sohler NL, Giovanniello A, Thompson D, Cunningham C. A buprenorphine education and training program for primary care residents: implementation and evaluation. Subst Abus. 2013;34(3):242–7.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Renner JA, Quinones J, Wilson A. Training psychiatrists to diagnose and treat substance abuse disorders. Curr Psychiatry Rep. 2005;7(5):352–9.

    Article  PubMed  Google Scholar 

  17. Iannucci R, Sanders K, Greenfield SF. A 4-year curriculum on substance use disorders for psychiatry residents. Acad Psychiatry. 2009;33(1):60–6.

    Article  PubMed  Google Scholar 

  18. Rankin JG. The development of medical education on alcohol- and drug-related problems at the University of Toronto. Can Med Assoc J. 1990;143(10):1083–91.

    CAS  Google Scholar 

  19. Scott DM, McLaurin-Jones T, Brown FD, Newton R, Marshall VJ, Kalu N, et al. Institutional incorporation of screening, brief intervention, and referral to treatment (SBIRT) in residency training: achieving a sustainable curriculum. Subst Abus. 2012;33(3):308–11.

    Article  PubMed  Google Scholar 

  20. Sanchez-Ramirez JP, Gakhal R, Oakman SA. Addiction psychiatry in PGY-3: use of the intensive outpatient treatment setting to train senior residents. Acad Psychiatry. 2016;40(3):517–9.

    Article  PubMed  Google Scholar 

  21. Bhatraju EP, Chang A, Taff J, Hanley K. Revising residents’ addiction experience: a 1- week intensive course. Med Educ. 2016;50(11):1161.

    Article  PubMed  Google Scholar 

  22. Bray JH, Kowalchuk A, Waters V, Laufman L, Shilling EH. Baylor SBIRT medical residency training program: model description and initial evaluation. Subst Abus. 2012;33(3):231–40.

    Article  PubMed  Google Scholar 

  23. Bray JH, Kowalchuk A, Waters V, Allen E, Laufman L, Shilling EH. Baylor pediatric SBIRT medical residency training program: model description and evaluation. Subst Abus. 2014;35(4):442–9.

    Article  PubMed  Google Scholar 

  24. Clemence AJ, Balkoski VI, Schaefer BM, Lee M, Bromley N, Maisonneuve IM, et al. Multispecialty screening, brief intervention, and referral to treatment (SBIRT) training in an academic medical center: resident training experiences across specialties. Subst Abus. 2015;37(2):356–63.

    Article  Google Scholar 

  25. Clemence AJ, Balkoski VI, Lee M, Poston J, Schaefer BM, Maisonneuve IM, et al. Residents’ experience of screening, brief intervention, and referral to treatment (SBIRT) as a clinical tool following practical application: a mixed-methods study. Subst Abus. 2016;37(2):306–14.

    Article  PubMed  Google Scholar 

  26. Cole B, Clark DC, Seale JP, Shellenberger S, Lyme A, Johnson JA, et al. Reinventing the reel: an innovative approach to resident skill-building in motivational interviewing for brief intervention. Subst Abus. 2012;33(3):278–81.

    Article  PubMed  Google Scholar 

  27. Gunderson EW, Levin FR, Owen P. Impact of a brief training on medical resident screening for alcohol misuse and illicit drug use. Am J Addict. 2008;17(2):149–54.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Harris JM, Sun H. A randomized trial of two e-learning strategies for teaching substance abuse management skills to physicians. Acad Med. 2013;88(9):1357–62.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Holt SR, Segar N, Cavallo DA, Tetrault JM. The addiction recovery clinic: a novel, primary-care-based approach to teaching addiction medicine. Acad Med. 2017;92(5):680–3.

    Article  PubMed  Google Scholar 

  30. Kalu N, Cain G, McLaurin-Jones T, Scott D, Kwagyan J, Fassassi C, et al. Impact of a multi-component SBIRT training curriculum on a medical residency program. Subst Abus. 2016;37(1):242–7.

    Article  PubMed  Google Scholar 

  31. Karam-Hage M, Nerenberg L, Brower KJ. Modifying residents’ professional attitudes about substance abuse treatment and training. Am J Addict. 2001;10:40–7.

    Article  CAS  PubMed  Google Scholar 

  32. Levin FR, Owen P, Stinchfield R, Rabinowitz E, Pace N. Use of standardized patients to evaluate the physicians in residence program. J Addict Dis. 1999;18(2):39–50.

    Article  CAS  PubMed  Google Scholar 

  33. Marshall VJ, McLaurin-Jones TL, Kalu N, Kwagyan J, Scott DM, Cain G, et al. Screening, brief intervention, and referral to treatment: public health training for primary care. Am J Public Health. 2012;102(8):30–6.

    Article  Google Scholar 

  34. Nigwekar SU, Morse DS. Educational half day: an innovative way to incorporate substance abuse curriculum into residency training. Subst Abus. 2006;27(3):1–4.

    Article  PubMed  Google Scholar 

  35. Parish SJ, Ramaswamy M, Stein MR, Kachur EK, Arnsten JH. Teaching about substance abuse with objective structured clinical exams. J Gen Intern Med. 2006;21:453–9.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Parish SJ, Stein MR, Hahn SR, Goldberg U, Arnsten JH. Teaching and assessing residents’ skills in managing heroin addiction with objective structured clinical examinations (OSCEs). Subst Abus. 2013;34(4):350–5.

    Article  PubMed  Google Scholar 

  37. Rastegar DA, Fingerhood MI, Jasinski R. A resident clerkship that combines inpatient and outpatient training in substance abuse and HIV care. Subst Abus. 2004;25(4):11–5.

    Article  PubMed  Google Scholar 

  38. Ryan SA, Martel S, Pantalon M, Martino S, Tetrault J, Thung SF, et al. Screening, brief intervention, and referral to treatment (SBIRT) for alcohol and other drug use among adolescents: evaluation of a pediatric residency curriculum. Subst Abus. 2012;33(3):251–60.

    Article  PubMed  Google Scholar 

  39. Satterfield JM, Osullivan P, Satre DD, Tsoh JY, Batki SL, Julian K, et al. Using standardized patients to evaluate screening, brief intervention, and referral to treatment (SBIRT) knowledge and skill acquisition for internal medicine residents. Subst Abus. 2012;33(3):303–7.

    Article  PubMed  Google Scholar 

  40. Schram P, Harris SK, Van Hook S, Forman S, Mezzacappa E, Pavlyuk R, et al. Implementing adolescent screening, brief intervention, and referral to treatment (SBIRT) education in a pediatric residency curriculum. Subst Abus. 2015;36(3):332–8.

    Article  PubMed  Google Scholar 

  41. Seale JP, Shellenberger S, Clark DC. Providing competency-based family medicine residency training in substance abuse in the new millennium: A model curriculum. BMC Med Educ. 2010;10(33).

  42. Stein MR, Arnsten JH, Parish SJ, Kunins HV. Evaluation of a substance use disorder curriculum for internal medicine residents. Subst Abus. 2011;32(4):220–4.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Tetrault JM, Green ML, Martino S, Thung SF, Degutis LC, Ryan SA, et al. Developing and implementing a multispecialty graduate medical education curriculum on screening, brief intervention, and referral to treatment (SBIRT). Subst Abus. 2012;33:168–81.

    Article  PubMed  Google Scholar 

  44. Wakeman SE, Pham-Kanter G, Baggett MV, Campbell EG. Medicine resident preparedness to diagnose and treat substance use disorders: impact of an enhanced curriculum. Subst Abus. 2015;36(4):427–33.

    Article  PubMed  Google Scholar 

  45. Whittle AE, Buckelew SM, Satterfield JM, Lum PJ, O’Sullivan P. Addressing adolescent substance use: teaching screening, brief intervention, and referral to treatment (SBIRT) and motivational interviewing (MI) to residents. Subst Abus. 2015;36(3):325–31.

    Article  PubMed  Google Scholar 

  46. Beich A, Thorsen T, Rollnick S. Screening in brief interventions trials targeting excessive drinkers in general practice: systematic review and meta-analysis. BMJ. 2003;327(September).

  47. Jonas DE, Garbutt JC, Amick HR, Brown JM, Brownley KA, Council CL, et al. Behavioral counseling after screening for alcohol misuse in primary care: a systematic review and meta-analysis for the U.S. Preventive Services Task Force. Ann Intern Med. 2012;157(9):645.

    Article  PubMed  Google Scholar 

  48. Saitz R, Palfai TPA, Cheng DM, Alford DP, Bernstein JA, Lloyd-travaglini CA, et al. Screening and brief intervention for drug use in primary care: the ASPIRE randomized clinical trial. JAMA. 2014;312(5):502–13.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Bogenschutz MP, Donovan DM, Mandler RN, Perl HI, Forcehimes AA, Crandall C, et al. Brief intervention for patients with problematic drug use presenting in emergency departments: a randomized clinical trial. JAMA Intern Med. 2014;174(11):1736–45.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Young MM, Stevens A, Galipeau J, Pirie T, Garritty C, Singh K, et al. Effectiveness of brief interventions as part of the Screening, Brief Intervention and Referral to Treatment (SBIRT) model for reducing the nonmedical use of psychoactive substances: a systematic review. Syst Rev. 2014;3(50).

  51. Hingson R, Compton WM. Screening and brief intervention and referral to treatment for drug use in primary care: back to the drawing board. JAMA. 2014;312(5):488–9.

    Article  CAS  PubMed  Google Scholar 

  52. Kim TW, Bernstein J, Cheng DM, Lloyd-Travaglini C, Samet JH, Palfai TP, et al. Receipt of addiction treatment as a consequence of a brief intervention for drug use in primary care: a randomized trial. Addiction. 2017;112(5):818–27.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Saitz R. Screening and brief intervention for unhealthy drug use: little or no efficacy. Front psych. 2014;5:121.47.

    Google Scholar 

  54. Fudala PJ, Bridge TP, Herbert S, Williford WO, Chiang CN, Jones K, et al. Office-based treatment of opiate addiction with a sublingual-tablet formulation of buprenorphine and naloxone. N Engl J Med. 2003;349(10):949–58.

    Article  CAS  PubMed  Google Scholar 

  55. Strain EC, Stitzer ML, Liebson IA, Bigelow GE. Dose-response effects of methadone in the treatment of opioid dependence. Ann Intern Med. 1993;119:23–7.

    Article  CAS  PubMed  Google Scholar 

  56. Liebschutz JM, Crooks D, Herman D, Anderson B, Tsui J, Meshesha LZ, et al. Buprenorphine treatment for hospitalized, opioid-dependent patients: a randomized clinical trial. JAMA Intern Med. 2014;174(8):1369–76.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  57. Platt L, Minozzi S, Reed J, Vickerman P, Hagan H, French C, et al. Needle syringe programmes and opioid substitution therapy for prevention hepatitis C transmission in people who inject drugs. Cochrane Database Syst Rev. 2017;9:CD012021.

    PubMed  Google Scholar 

  58. MacArthur GJ, Minozzi S, Martin N, Vickerman P, Deren S, Bruneau J, et al. Opiate substitution treatment and HIV transmission in people who inject drugs: systematic review and meta-analysis. BMJ. 2012;345:e5945.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Ram A, Chisolm MS. The time is now: improving substance abuse training in medical schools. Acad Psychiatry Academic Psychiatry. 2016;40:454–60.

    Article  PubMed  Google Scholar 

  60. McCance-Katz EF, George P, Scott NA, Dollase R, Tunkel AR, McDonald J. Brief report : access to treatment for opioid use disorders: medical student preparation. Am J Addict. 2017;26:316–8.

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors wish to thank Mrs. Katherine Stemmer Frumento for her assistance in the design and conduct of our search strategy for this review.

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Authors and Affiliations

  1. Division of Addiction Medicine, Johns Hopkins University School of Medicine, Baltimore, USA

    Ryan Graddy

  2. NYU Division of General Internal Medicine, Brooklyn, USA

    Anthony J. Accurso

  3. Division of General Internal Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA

    Deepa Rani Nandiwada & Marc Shalaby

  4. General Internal Medicine, Yale School of Medicine, 1450 Chapel Street, New Haven, CT, 06510, USA

    Stephen R. Holt

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Correspondence to Stephen R. Holt.

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Graddy, R., Accurso, A.J., Nandiwada, D.R. et al. Models of Resident Physician Training in Opioid Use Disorders. Curr Addict Rep 6, 355–364 (2019). https://doi.org/10.1007/s40429-019-00271-1

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