Addiction Medicine Education by Margaret Chisolm

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Addiction Medicine Education

Published on Nov 18, 2015

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PRESENTATION OUTLINE

Understanding the Nature of Addiction

Interprofessional Education Series, 3/9/18

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MARGARET S. CHISOLM, MD

@WHOLE_PATIENTS

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CENTER FOR ADDICTION & PREGNANCY

JOHNS HOPKINS BAYVIEW

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DISCLOSURES

NO RELEVANT FINANCIAL RELATIONSHIPS WITH COMMERCIAL INTERESTS

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OBJECTIVES

Describe the growing demand for substance abuse prevention & treatment
Summarize the literature on current insufficiencies in substance abuse training
Describe strategies to address this gap in physician education

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PREVENTION & TREATMENT NEEDS

THE SCOPE OF THE PROBLEM

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SUBSTANCE USE

CAUSE OF ~25% OF ALL DEATHS IN U.S.

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20.6 MILLION UNTREATED

90% OF INDIVIDUALS WHO NEED TREATMENT

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BARRIERS TO TREATMENT

AVAILABILITY, ACCESSIBILITY, AFFORDABILITY, ACCEPTABILITY

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10.

SPECIALTY SUBSTANCE ABUSE TREATMENT

SPECIALISTS, FREE-STANDING, INTENSIVE, ONE-SIZE FITS ALL

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NON-SPECIALTY TREATMENT

MORE PROVIDERS, USUAL SETTING, LESS INTENSIVE, FLEXIBLE & EARLY INTERVENTION

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MENTAL HEALTH PARITY & AFFORDABLE CARE ACTS

SUBSTANCE TREATMENT NOW AN ESSENTIAL SERVICE OF HEALTH CARE PLANS

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U.S. = 5% OF WORLD POPULATION

BUT CONSUMES 80% OF GLOBAL OPIOID PAIN RELIEVER SUPPLY

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QUADRUPLED IN PAST 15 YEARS

OVERDOSE DEATHS DUE TO OPIOIDS

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HEROIN USERS

WHITE, MIDDLE CLASS MEN & WOMEN LIVING IN SUBURBIA

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16.

ALL PHYSICIANS NEED TO KNOW

Impact of substance use on specialty's conditions
Physician's role in prevention & treatment

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17.

ADDICTION SPECIALISTS

WELL-TRAINED IN EVIDENCE-BASED TREATMENTS FOR SUBSTANCE USE DISORDERS

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ALL PHYSICIANS

WELL TRAINED IN SCREENING/DIAGNOSIS, EARLY INTERVENTION, & REFERRAL

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CORE DEFICIENCIES

IN SCREENING FOR & MANAGING PATIENTS WITH SUBSTANCE USE

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<1/3 OF PRIMARY CARE PHYSICIANS

SCREENING FOR SUBSTANCE USE PERFORMED BY

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25-50% SUCCESS RATE

AT DETECTING SUBSTANCE USE DISORDERS IN OUTPATIENT CLINICS

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ONLY 55% OF PHYSICIANS REFER TO TREATMENT

PATIENTS WITH RECOGNIZED ILLICIT DRUG USE

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23.

THE PROBLEM FOR PHYSICIANS

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"DIFFICULT AND UNPLEASANT"

"PERIPHERAL TO OR OUTSIDE MEDICAL MEDICAL MATTERS"

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INADEQUATE SUBSTANCE USE TRAINING

UNDERGRADUATE & GRADUATE MEDICAL EDUCATION

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26.

HOURS

ALLOTTED TO TOPIC OF SUBSTANCE USE IN MED SCHOOLS

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41% HAVE ZERO CURRICULUM

DEVOTED TO SUBSTANCE USE DISORDERS

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BARRIERS TO SUBSTANCE USE TEACHING

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29.

LCME

2014 STANDARDS MAKE NO MENTION OF SUBSTANCE USE

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FOCUS ON KNOWLEDGE TRANSMISSION

VS. ATTITUDE & SKILL DEVELOPMENT

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SBIRT

SCREENING, BRIEF INTERVENTION, & REFERRAL TO TREATMENT

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"CYNICAL" TRAINING

HIDDEN CURRICULUM IN 3RD & 4TH YEARS OF MEDICAL SCHOOL

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WHERE STUDENTS SEE SUBSTANCE-USING PATIENTS

ACUTE HOSPITAL ED, MEDICINE WARDS, DETOX & PSYCH UNITS

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CLINICAL TRAINING OPPORTUNITES

NON-ACUTE SETTING WITH CARING ROLE MODELS PRACTICING EBM

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RESIDENCY TRAINING

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39.

BUPRENORPHINE & BUPRENORPHINE/NALOXONE

APPROVED BY FDA IN 2002

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40.

PRESCRIBING BUPRENORPHINE

REQUIRES WAIVER ELIGIBILITY TRAINING

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ADDICTION PSYCHIATRY & ADDICTION MEDICINE CERTIFICATION

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42.

HOPKINS SUBSTANCE ABUSE TRAINING

MEDICAL STUDENTS

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HOPKINS SUBSTANCE ABUSE TRAINING

RESIDENTS & POST-DOCTORAL FELLOWS

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