(34) Opioid Use Disorder Treatment Training Impacts Future Residents’ Attitudes and Perceptions

Introduction: Drug overdoses in the U.S. increased 30.8% from March 2020 to March 2021.1 Only 10% of people living with opioid use disorder (OUD) are receiving treatment.2 The stigma surrounding substance use disorders (SUDs) is a frequently cited barrier to treatment engagement. Research consistently demonstrates that healthcare professionals' attitudes towards patients with addiction problems are often negative and may adversely impact service delivery.3 The risk factors that can cause clinician bias include lack of awareness of the health condition and uncertainty as to how to treat it.4 Integration of training into medical school curriculum results in reduced stigma toward OUD among residents and increases access to care for this underserved patient population.

Methods: UPSOM integrated medications for opioid use disorder (MOUD) training elements into fourth-year medical students (MS4) curriculum beginning October 2021 including the 8-hour Providers Clinical Support System (PCSS) core training, case evaluations, clinical experiences with MOUD providers, and special topics modules addressing the intersection between chronic pain, medical marijuana and OUD, and racial disparities and equity in accesses to SUD and OUD treatment. MS4 participated in faculty-facilitated virtual trainings in October and November 2020. The curriculum included the pharmacology of opioids, OUD assessment, MOUD induction and maintenance, evidence-based antagonist and agonist OUD medications, treatment adherence support, and special population treatment considerations. Clinical observation experiences focused on patient engagement in treatment decisions, assessment, and referral collaboration with behavioral health supports.

Results: Training outcomes were evaluated using a pre- and post-training survey method. Evaluation domains included changes in attitudes and perceptions towards patients using substances and anticipated MOUD practice intent. Six-month post-training surveys assessed long-term impacts on perceptions and practice of MOUD treatment.
The following mean group post-training increases were identified:
• Perceived MOUD practice competency increased by 3%-37% in all 9 measured areas.
• Positive attitudes and perceptions towards working with patients using substances increased by 4%-28% in 9 of 12 measured areas. Greater impacts were seen in areas with the lowest pre-training ratings related to feelings of competence and satisfaction in working with patients using drugs.
• Most trained students (93%) responding to a six-month post-graduation survey strongly agreed or agreed that MOUD treatment is effective in producing positive patient outcomes.

Conclusion: Results indicate that integrating MOUD training into medical school curricula is feasible and an effective way to improve resident perceptions of OUD treatment and increase access to care. Other academic institutions may benefit from implementing similar strategies to the integration of MOUD training.

Support for this project is provided by the Substance Abuse and Mental Health Services Administration grant H79TI082567.

References:
1. Ahmad FB, Rossen LM, & Sutton P. Provisional drug overdose death counts. National Center for Health Statistics. 2021. https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm. Accessed January 20, 2022.
2. National Academies of Sciences, Engineering, and Medicine. Medications for opioid use disorder save lives. 2019. Washington, DC: The National Academies Press. doi.org/10.17226/25310. Accessed January 20, 2022.
3. Bielenberg, J, Swisher, G, Lembke, A, & Haug, NA. A systematic review of stigma interventions for providers who treat patients with substance use disorders. J Subst Abuse Treat. 2021; 131:108486. doi.org/10.1016/j.jsat.2021.108486.
4. Chapman EN, Kaatz A, Carnes M. Physicians and implicit bias: how doctors may unwittingly perpetuate health care disparities. J Gen Intern Med. 2013;28(11):1504-1510. doi:10.1007/s11606-013-2441-1