uniting and leading through np education: educating nurse ... · • during the 1980’s and...

Uniting and Leading through NP Education:Uniting and Leading through NP Education:

Educating Nurse Practitioner Students Across Populations RegardiEducating Nurse Practitioner Students Across Populations Regarding ng

Their Roles in Caring for Clients with Opioid Use Disorder and Their Roles in Caring for Clients with Opioid Use Disorder and

Chronic PainChronic Pain

The International Nurses Society on AddictionsThe International Nurses Society on Addictions

4141stst Annual ConferenceAnnual Conference

October 19, 2017October 19, 2017

Dana Murphy-Parker, MS, CRNP, PMHNP-BC, CARN-AP, FIAAN

Jennifer Coates, MSN, MBA, ACNP-BC, ACNPC

Brenda Douglass, DNP, APRN, FNP-C, CDE, CTTS

Heather Frye, APRN, PMHNP-BC, MSN, MBA

Susan Solecki, DrPH, FNP-BC, PPCNP-BC

Jill M. Terrien, PhD, ANP-BC

The International Nurses Society on Addictions

Mission StatementMission Statement

• To advance excellence in nursing

care for the prevention and

treatment of addictions for diverse

populations across all practice

settings through advocacy,

collaboration, education, research

and policy development.

2

https://obamawhitehouse.archives.gov/the-press-office/2015/10/21/presidential-memorandum-addressing-prescription-drug-

abuse-and-heroin

3College of Nursing and Health Professions

Presidential Memorandum -- Addressing Prescription Drug Abuse and Heroin Use

White HouseFor Immediate Release: October 21, 2015

• This directive from President Obama, was based on the tragic national epidemic involving prescription opioids and heroin which quadrupled more than 16,000 deaths in the United States between 1999 and 2013. The Memoranda stated that all health professionals who spend 50 percent or more of their clinical time under contract with the Federal Government, and prescribed controlled substances within the terms and conditions of their contract must obtain this training.

• The Presidential Memoranda declared that training must include the following:

● best practices for appropriate, and effective, prescribing of opioid pain medications

● principles of pain management

● proper methods for disposing of controlled substances

● misuse potential of controlled substances

● identification of potential substance use disorders

● referral to further evaluation and treatment

American Association of Colleges of Nursing (AACN)

• AACN Announcement on Initiative on the Opioid Crisis

• http://www.aacn.nche.edu/opioids

• AACN Opioid Crisis Webinars

• file:///C:/Users/dam355/Downloads/20170312_00001%20(8).pdf

Commitment from American Association of Colleges of Nursing (AACN) to educate and combat opioid crisis and prescription drug

abuse (April, 2016)

http://www.aacn.nche.edu/news/articles/2016/opioids

"Academic nursing is committed to protecting the public's healthby taking decisive action to address the nation's opioid epidemic," said Dr. Trautman. "I applaud my colleagues in the nursing community who have made it a priority to prepare the next generation of APRNs on best practices for prescribing opioids."

1. Educate APRN’s about opioid crisis.

2. Educate APRN students on the Centers for Disease Control and Prevention's (CDC) Guideline for Prescribing Opioids for ChronicPain.

Tuesday, October 31, 2017 Drexel University College of Nursing and Health Professions 6

How did we get here?How did we get here?

• Pain as ‘the 5th vital sign’ contributed to increased prescribing of

opioids for pain, and at the same time increased the availability of

opioids for diversion and misuse of opioids.

• During the 1980’s and 1990’s pain management was equated to

prescribing opioids for pain.

• There is a serious problem of diversion and abuse of opioid drugs.

• 75% of opioid overdoses were people using opioids for non-medical

reasons.

• Treatment dichotomy. Opioids do legitimately relieve pain, and help

those with chronic pain disorders to be more functional; however, at

the same time, there are those who use these substances and it goes

to their reward system, and increases misuse of prescription opioid

medications, and can lead to an Opioid Use Disorder.


N Engl J Med. 1980, Jan 10 (302)

• Addiction is Rare in Patients Treated with Narcotics

________________________________________________

• The newly approved Joint Commission on Accreditation of Healthcare Organizations (JCAHO) pain management standards present an important opportunity for widespread and sustainable improvement in pain assessment and management.

• Unrelieved pain is a major, yet avoidable, public health problem. Despite 20 years of work by educators, clinicians, and professional organizations and the publication of clinical practice guidelines, there have been, at best, modest improvements in pain management practices.

• (Berry & Dahl, (2000). The new JCAHO standards: Implications for pain management nurses). Pain Management Nursing, 1 (1), 3-12.


A decision to advance opioid dosing should not be based A decision to advance opioid dosing should not be based

solely on pain scores, but should include a comprehensive solely on pain scores, but should include a comprehensive

functional assessment (Treisman & Clark, 2011). functional assessment (Treisman & Clark, 2011).


CDC Guideline for Prescribing Opioids for Chronic PainCDC Guideline for Prescribing Opioids for Chronic Pain——

United States, March 16, 2016United States, March 16, 2016

There are 12 recommendations. Of

primary importance, nonopioid therapy is

preferred for treatment of chronic pain.

Opioids should be used only when

benefits for pain and function are

expected to outweigh risks.

Recommendations from CDC


A Call for CollaborationA Call for Collaboration

Interdisciplinary Approach

● Pediatric Nurse Practitioner

•Acute Care Nurse Practitioner

•Psychiatric Nurse Practitioner

•Family Nurse Practitioner


Interdisciplinary Case Discussion

• John Smith is an 18 year old male high school student who presents to the PPCNP office accompanied by his mother. John’s mother is worried

about his alcohol and drug use.

• John required knee surgery 3 months ago impacting his athletic

performance in wrestling and is anxious regarding obtaining an athletic scholarship for college.

• John was ordered oxycodone in the post-op period. After evaluation, his

orthopedic surgeon ordered NSAIDS and physical therapy for rehabilitation however, John states his knee was “never right” after the

surgery.

• John’s mother states that since his surgery, John’s grades have dropped in school although he is a good student, is having mood swings, and has

come home “drunk and appearing high” after partying with friends.

• When interviewed alone, John admits to alcohol and marijuana use. He

states he has also been “borrowing prescription medications” from his friends.

12

The Pediatric Opioid Abuse Epidemic • Opioid prescriptions to adolescents and young adults nearly doubled from

1994 to 2007.5

• After marijuana, prescription medications are the drugs most commonly abused by the adolescent population with the biggest growth of abuse among persons aged 12 to 24 years.5

• An estimated 14% of high school seniors have used prescription drugs for non-medical reasons at least once.5

• Female teenagers, in particular, see prescription pills as “cleaner” than other drugs, and equal their male counterparts in prescription drug use, but are less likely to use marijuana or cocaine compared to males.5

• Student athletes may see pills as a way to enhance sports performance or may self-medicate with opiates for pain related to sports injuries. 5

• Seventy percent of all people who abused prescription pain relievers obtained them from friends or relatives, often without permission.9

The Neurobiology of Adolescence and Addiction Vulnerability

• Adolescence is a period of dynamic biologic, It is also a time of enhanced sensitivity to stress. psychological, and behavioral changes.1

It is also a time of enhanced sensitivity to stress.

• Developmental changes in neural circuitry may contribute to vulnerability for increased levels of engagement in substance use and nonsubstance

addictive behaviors.1

Also, because white matter and hippocampal development is still being laid down in teens,

their brains are more susceptible to destructive effects of drugs including impaired pre-fontal cortex function, working memory, and motor coordination.

• The chief predictor of adolescent behavior is not the perception of risk, but

the anticipation of the reward despite the risk.3

Studies suggest that more than 80% of adolescents experiment

with drugs or alcohol before adulthood.2

14

Biologic Models of Adolescent Vulnerability

• The midbrain dopaminergic system

A common neural pathway of reward that with repeated drug exposures in susceptible individuals may prime neuro circuits. Over time addictive behaviors may “hijack” the

brain’s natural reward system, making it more responsive to the primary drug of abuse and less responsive to other “natural” reinforcers/rewards.

• Stress-associated neuroplasticity Stressors can turn on genes that can lead to the dysregulation of the HPA. The use of

substances to relieve the stress also dysregulates the HPA axis, leading to a vicious cycle of worsening sensitivity to stress each time substances are used to relieve the

stress.

• Maturational imbalances between cognitive control and reward reactivity

Adolescence is a period where two separate entities are independently working, lack of cognitive control (immature prefrontal cortex) and risk taking (due to earlier

maturation of the nucleus accumbens.

15

Adolescents at Risk for Substance Abuse Disorders

•Genetics

•Environmental

•Comorbidities

•Personality

•Age

16

Turning The Tide

On August 26, 2016 the U.S. Surgeon General implored clinicians to take a more

active role in stemming the opioid crisis by asking them to sign a 3-pronged online pledge:

1. First, to educate yourself on how to safely and effectively treat pain.

2. Second, to screen your patients for opioid use disorder and provide or connect

them with evidence based treatment.

3. And finally, to discuss and treat opioid addiction as the chronic illness it is—not a moral failing.

These are the children in your waiting room right now (turnthetiderx.org).

“We, as clinicians, are uniquely positioned to turn the tide on the opioid

epidemic.”

- US SURGEON GENERAL

VIVEK MURTHY, MD, MBA

Contemporary Pediatrics, 2016

Signs and Symptoms of Opioid Abuse

• Sudden change in personality without another known cause

• Anhedonia

• Sudden decline in school performance

• Change in friends

• Deterioration of hygiene

• Loss of concentration

• Lability

• Increased in secretiveness

Screening for Opioid Problems

• Developmental Problems

• School related problems• Risky Sexual Practices

• Delinquent Behavior• Urine Drug Screens

• CAGE-AID1. Have you ever felt you ought to cut down on your drinking or drug use? 2. Have people annoyed you by criticizing your drinking or drug use? 3. Have you felt bad or guilty about your drinking or drug use? 4. Have you ever had a drink or used drugs first thing in the morning to steady your nerves or to

get rid of a hangover (eye-opener)?

• CRAFFTC - Have you ever ridden in a CAR driven by someone (including yourself) who was "high" or had been using

alcohol or drugs? R - Do you ever use alcohol or drugs to RELAX, feel better about yourself, or fit in? A - Do you ever use alcohol/drugs while you are by yourself, ALONE? F - Do you ever FORGET things you did while using alcohol or drugs? F - Do your family or FRIENDS ever tell you that you should cut down on your drinking or drug use? T - Have you gotten into TROUBLE while you were using alcohol or drugs?

ASAM National Guidelines for

Treatment

The Role of The HCP

• Routine office screening must incorporate prescription drug and recreational drug use such as pharming

parties and skittling screening in all risk-taking behavior assessments.

• HCPs should be conservative and prudent when prescribing not only painkillers and controlled substances

but also all medications.

• HCPs should remain vigilant and question frequent refills or multiple prescriptions for commonly abused

medications and be cognizant of patients who “doctor shop” or “ED hop.”

• HCPs share a responsibility to support legislation that might curb access to nonregulated Internet

pharmacies and the sale of medications without prescriptions.

• Provide anticipatory guidance in emphasizing the importance of the parent-child relationship (open

communication and engagement) as a protective factor in keeping children safe.

• Educate families:1. to keep medicine cabinets locked and keep prescription drugs out of reach or out of range for both their children and friends who may

be visiting.

2. on how to prevent accidental ingestion by children, pets, or anyone else.

3. that certain expired, unwanted, or unused medicines have specific disposal instructions that indicate if they should be flushed down the sink or toilet as soon as they are no longer needed, or when they should be disposed of through a medicine take-back program.

Interdisciplinary Case DiscussionInterdisciplinary Case Discussion

• Before John can get evaluated by mental health services for substance abuse as recommended by his PNP, he gets pulled over by the police after a “skittling party” for reckless driving on his

motorcycle. He is charged with driving under the influence and is taken to the ER for erratic behavior and evaluation of minor injuries. While in the ER, John has a respiratory arrest.

• Toxicology drug screen was positive for opioids.



• Priority of care is acute resuscitation and stabilization

• Important to obtain as much pertinent information as possible regarding

substance(s) consumed (type, amount, timing)

• Transfer to ICU should be early on to ensure continued care of the patient

• A comprehensive history is imperative for the ICU provider assuming care


• Challenges to the ENP role:

–Level of consciousness

–Lack of cooperation

–Denial of problem

–Embarrassment

25


Patient transferred

from ED to ICU

Critical Care Challenges• Medical stabilization is always the priority

• An immediate interview with the patient may not be possible; may need to rely on family, love ones, or witnesses of the event to provide the history

• Background information would be helpful to establish treatment plan

• Monitor for potential withdrawal from substance(s)

• Developing a trusting patient relationship is important although patients may be downgraded shortly after being extubated

27

Critical Care Day #2Day #2

• He is extubated, awake and alert

• Transferred out of ICU• Consult placed to inpatient psych NP for

drug evaluation



Patient steps

down to medical floor

and a psychiatric

consultation is

ordered

The Psychiatric Mental Health Nurse The Psychiatric Mental Health Nurse

Practitioner (PMHNP) role as Practitioner (PMHNP) role as ‘‘Consultation Consultation

LiaisonLiaison’’ in General Hospital settingin General Hospital setting

• Bring specialized clinical skills with expertise in

communication, facilitation, relationahip dynamics,

and interpersonal and organizational systems

(Broom, C., Shirk, M.J., Pehrson, K.M & Peterson,

K. (2008).

• Meet with the patient and establish a therapeutic

relationship with him.

• Discuss with the patient the neurobiological chronic

disorder of addiction.

• Explain importance of screening related to his

current situation.

• Discuss with client with follow-up after discharge

for full psychiatric evaluation.


Screening, Brief Intervention and Referral to Treatment

(SBIRT)

What is SBIRT?

SBIRT is a comprehensive, integrated, public health approach to the delivery of early intervention and treatment services for persons with substance abuse use disorders, as well as those who are at risk of developing these disorders. Primary care centers, hospital emergency rooms, trauma centers and other community settings provide opportunities for early intervention with at-risk substance users before more severe consequences occur.


Screening, Brief Intervention and Referral to Treatment

(SBIRT)

• Screening is a quick, simple way to identify patients who need further assessment

• Brief intervention is a single session or multiple sessions of motivational discussion

• Brief treatment is a distinct level of care and is a communication strategic to facilitate behavior change.

• Referral to specialized treatment is provided to those identified as needing more extensive


Screening Tools for Screening, Brief Screening Tools for Screening, Brief

Intervention, & Referral to TreatmentIntervention, & Referral to Treatment

Where can I find information on screening tools? A number of substance abuse screening tools have been developed. The use of instruments may vary based on State or local regulations, reimbursement

policies, or personal preference.

Psychiatric NP students are given both lecture and simulation experience in learning how to screen for

Substance Use Disorders (http://www.integration.samhsa.gov/clinical-practice/screening-tools)


Screening Tools for Screening, Brief Screening Tools for Screening, Brief

Intervention, & Referral to TreatmentIntervention, & Referral to Treatment

The Alcohol Use Disorders Identification Test (AUDIT), available at: http://libdoc.who.int/hq/2001/WHO_MSD_MSB_01.6a.pdf

The Drug Abuse Screening Test (DAST), available at: http://www.projectcork.org/clinical_tools/pdf/DAST.pdf

The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), available at: http://www.who.int/substance_abuse/activities/assist_v3_english.pdf


Rachel Humeniuk1, Robert Ali1, Thomas F. Babor2, Michael Farrell3, Maria L. Formigoni4, Jaroon Jittiwutikarn5, Roseli B. de

Lacerda6, Walter Ling7, John Marsden3, Maristela Monteiro8, Sekai Nhiwatiwa9, Hemraj Pal10, Vladimir Poznyak8 & Sara Simon7

(2009).Validation of the alcohol, smoking and substance involvement screening test (ASSIST). World Health Organization;

Addiction Report

A Screening Tool developed by the WHO

and screens for all substances; Alcohol,

Tobacco, All illicit drugs; all prescription

medications, and all OTC medication

resulting in a score.


Alcohol, Smoking and Substance

Involvement Screening Test (ASSIST)

Psychoeducation of Opioid Health

Consequences


Upon discharge, the patient is referred to f/u

with Primary Care.

Primary Care PerspectivePrimary Care Perspective


• Safe and proper use/prescribing of controlled substances

– Assessment; etiology of pain; diagnostic work-up; establish

treatment goals

– EBP recommendations

– Discuss benefits and risks (e.g. addiction, overdose) with

patient

• Clinical tools (CDC)

– How and when to taper

• Pain Management Contracts

– Organizational policy/legal considerations

• Monitoring

– Urine Drug Screen (UDS); serum (CDC, 2017 Aug.)


Primary Care PerspectivePrimary Care Perspective

• Interprofessional collaboration with all

referring specialties

• Identifying substance use/abuse/misuse

in the primary care setting

• Collaborative endeavors

– National Alliance for Model State Drug

Laws

– DEA

(DEA, 2017; NAMSDL, 2017)


(DEA, 2017; NAMSDL, 2017)

State Prescription Drug State Prescription Drug

Monitoring Program (PDMP)Monitoring Program (PDMP)

• Statewide electronic database; state regulated

• Collects designated data on substances

dispensed in the U.S.

• Authorized individuals under state law may

access information for purposes of their

profession

• 50 states have PDMP; 36 states mandate use of

PDMPs


(DEA, 2017; NAMSDL, 2017)

State Prescription Drug State Prescription Drug

Monitoring Program (PDMP)Monitoring Program (PDMP)

• Benefits: PDMP is a tool used by states to address

prescription drug abuse, addiction and diversion

– Supports access to legitimate medical use of controlled

substances

– Identify & deter or prevent drug abuse/diversion

– Identify, intervene, and treatment of persons with

prescription drug addiction

– Identifying abuse trends

– Education about PDMPs use, abuse, & addiction to

prescriptions drugs


(DEA, 2017; NAMSDL, 2017)

Ethical ConsiderationsEthical Considerations• Patient advocacy

– Protect confidentiality; legal age

– Information obtained in a PDMP – open communication

with patients

– If suspected addiction/diversion, refer for intervention

• Legal considerations

– Consult State PDMP for patients treated with controlled

substances where required by law

– PDMP record use when information is relevant

– Prescribe when appropriate

• Policy/Procedures

– Support clinical research to establish evidence relating to

best practices for opioid prescribing



• Develop a therapeutic relationship with the patient

• Discuss the reason for referral and current concerns

• Collaboration with patient to develop a treatment plan which will foster adherence

• Treatment plan to include individual/group psychotherapy if amenable

The Psychiatric Mental Health Nurse Practitioner (PMHNP) role in an outpatient setting


• Complete a psychiatric evaluation for assessment of a

co-occurring mental health and/or substance use disorder and gain a comprehensive understanding of

the identified substance use disorder

• Includes observation and interview

• Determine the appropriate level of care

• Review of medical records, diagnostic tests, and obtain history from collateral sources



• A complete a psychiatric evaluation includes a thorough

substance use history (for each substance):

• Quantity and frequency of use

• Route of administration• Pattern of use (e.g., episodic versus continual, solitary

versus social)

• Functional, interpersonal, or legal consequences of use• Tolerance and withdrawal phenomena

• Any temporal association between substance use and

other present psychiatric illnesses

• Any self-perceived benefits of use



• A complete a psychiatric evaluation includes a thorough

substance use history (for each substance):• Prior treatments for substance use disorders (outpatient,

IOP, residential, detoxification, h/o MAT, h/o

pharmacotherapy including Naltrexone/Vivitrol, Campral,

Antabuse)

• Periods of sustained abstinence, including their duration, recentness, and factors that aided in sobriety or contributed

to relapse

• Evaluation includes family history of both disorders of

addiction and mental health disorders



• Urine or buccal toxicology ordered in office with script

for additional lab testing if appropriate• Basic laboratory tests

• Pregnancy test

• Thyroid function test• Lyme serology

• Syphilis serology, HIV, HCV


• Psychiatric screening tools administered to provide baseline measurement:

• Patient Health Questionnaire (PHQ-9): Depression

• Hamilton Anxiety Rating Scale (HARS): Anxiety• Opioid Risk Tool

• PDMP Report

Opioid Use

Opioid Use

No single factor determines whether a

person will become addicted

to drugs.

Opioid Use

Disorder is a medical diagnosis

What Can We do?What Can We do?1. SBIRT (Screening, Brief Intervention, Referral to Treatment)

2. Prescription Drug Monitoring Programs

3. Ask! “Do you have a history of addiction?”

“Does anyone in your family have a history of addiction?”

4. Use of Opioid Risk Tool

5. Toxicology Screens

6. Know the resources:

– Providers Clinical Support Systems (PCSS) http://pcss-o.org/

– International Nurses Society on Addictions www.intNSA.org

– PainEDU: www.painedu.org

– American Society of Pain Educators: http://www.paineducators.org/


Work TogetherWork Together

Opioid and Safe-prescribing Training

Immersion (OSTI): a multi-modal,

competency-driven and performance-based

interprofessional program –University of

Massachusetts Medical School Experience

Jill Terrien PhD, ANP-BC Presenter with acknowledgement to , Mary Zanetti, EdD

Jean Boucher PhD, ANP-BC, Melissa Fischer, MD, MEd University of Massachusetts Worcester Graduate School of Nursing

University of Massachusetts Medical School

Education meeting the needs of our

patients and the community

• How do providers: MD, NP, PA, RN, SW others gain

the education needed to assess, treat, recognize and

manage opioid use disorder across the lifespan?

• Classroom and simulation utilized within primary

education continuing education and beyond.

• Concepts in UMMS Simulation brought out in the

unfolding case of John Smith.

| |

• MA medical schools developed 10 competencies re:

prevention & management of prescription drug misuse

• Our goals were to:

– train graduating students in safe and effective

opioid prescribing (MD and NP students);

– prevent and minimize risks of addiction;

– identify and treat patients with substance misuse

disorders.• Antman, K. H., Berman, H. A., Flotte, T. R., Flier, J., Dimitri, D. M., & Bharel, M. (2016). Developing Core Competencies for the

Prevention and Management of Prescription Drug Misuse: A Medical Education Collaboration in Massachusetts. Academic

Medicine, 91(10), 1348-1351.

The problem: a high prevalence of pain coexists with a public health crisis of opioid abuse: National and Local

GovernorGovernor’’s Working Groups Working Group

10 Competencies (Summary)

Prevent•Screen•Evaluate•Identify and Describe Options

Treat At-Risk Patients•Patient Engagement in Patient Centered Treatment Plan

Manage Substance Use Disorder•As a Chronic Disease•Eliminate Stigma

•Build Awareness of Social Determinants

Medical Education: http://www.mass.gov/eohhs/docs/dph/stop-addiction/governors-medical-

education-working-group-core-competencies.pdf

| |

Students (3rd & 4th year medical students, graduating nurse

practitioner students (FNP, AG-ACNP, AG-PCNP)) – not

graded, safe learning environment

•4-hour sessions April-June 2016 & Mar-June 2017:

– 2 hours: team of 1 faculty + 4 students participate in 4

½ hour scenarios with standardized patients (round-

robin style, each learner had a case)

– 2 hours: students attend patient panel discussion (1 hr,

facilitated by faculty) and naloxone training/case 5 (1

hr)

OSTI overview

| |

• Preparation:

– self-study in www.scopeofpain.com

– Faculty Development Live session (2 hours) or webinar

– not expected to be content experts; provide feedback;

emphasize key points; engage all learners; maintain safety

• Interprofessional and Interdisciplinary

- Nursing, Medicine, Pharmacy, Dentistry, Behavioral Medicine

- UMMS, VA, St Vincent’s, Cape Cod HC, Berkshire Medical Center,

Baystate Health Systems, Commonwealth Medicine, Private Community,

Fitchburg Family Health Centers

Faculty facilitators

| |

• Acute traumatic pain in a patient of color who is appropriate for treatment with opioids (orthopedic clinic)

• Chronic low back pain in a patient at high risk for opioid misuse - opioids should be discontinued (fam med clinic)

• Acute on chronic low back pain in a long-term patient on opioids; demonstrates aberrant behaviors but can continue with opioids with safeguards; nasal naloxone co-prescribed for safety (primary care clinic)

• Young woman with post-op pelvic pain and opioid misuse who requires intervention and referral to substance use treatment. (OB/GYN clinic)

• Patient s/p naloxone rescue in the field with partner in ED, rehab counseling and naloxone training

OSTI Cases

| || |

• Patients in recovery from Opioid addiction &/or their family members (2-4)—faculty facilitated

• Participants reflected on two open ended questions after the 45” encounter:

“One bias you had regarding caring for

these patients before this panel?”

“One way you think this panel will impact your care of these patients in the future?”

OSTI Panel Discussion & Self-Reflection

| || |

• Program:

– Overall high quality experience (learners and

faculty)

– Satisfied with learning experience

• Post program:

– ‘overall, the program provided me with

knowledge that I use regularly’

Outcomes/Evaluations of OSTI

| || |

Healthcare learned bias:‘I feel like we absorb a lot of unconscious bias from our attending and those higher in the "hierarchy“’

Judging:‘I think the toughest bias to overcome is judging a patient based on his/her appearance’

General knowledge (lack of):‘I was not aware of the patients low self esteem caused by their substance abuse’

Blaming/mistrust of patients:‘Regardless of what they say or how they appear, you cannot believe them as their goal is to deceive you.’

Learners’ self-reflection: Bias

| || |

Improved medical knowledge:

‘I will always screen children for substance abuse and care about

them.’

Seeing the whole patient:

‘Understand addiction can happen to anyone’

‘Treat everyone like a human being.’

Learn about and utilize available resources:

‘I am a compassionate individual but I will do more to educate

myself of the local resources for addicts’

Advocacy: ‘The panel brings forward good points that health care

providers play a large role in changing policy’

‘Seeing the positive impact of recovery will inspire me to help

addicts get resources for recovery.’

Learners’ self-reflection: Impact

• Curricula need to be flexible to accommodate changing needs

• Partnerships across schools and community organizations can

support that

• This is one example of simulation: there is much to be done in

the education of all healthcare providers.

• “The mentality and behavior of drug addicts and

alcoholics is wholly irrational until you understand that they are completely powerless over their addiction and unless they have structured help,

they have no hope.”• Russell Brand: Actor, Comedian, Author

In SummaryIn Summary

Thank you for your timeUMMS Opioid Conscious Curriculum Website: http://www.umassmed.edu/opioid/

65 | |

References• https://www.scopeofpain.com/ Live or online medical or cont nursing education to

manage chronic pain when appropriate with opioid analgesics safely and effectively

• http://umassmed.edu/opioid UMass Medical School website with resources and

materials

• Alford, D. P., Carney, B. L., Brett, B., Parish, S. J., & Jackson, A. H. (2016). Improving

Residents' Safe Opioid Prescribing for Chronic Pain Using an Objective Structured Clinical

Examination. J Grad Med Educ, 8(3), 390-397. doi:10.4300/jgme-d-15-00273.1

• Antman, K. H., Berman, H. A., Flotte, T. R., Flier, J., Dimitri, D. M., & Bharel, M. (2016).

Developing core competencies for the prevention and management of prescription drug

misuse: A medical education collaboration in Massachusetts. Academic Medicine, 91(10),

1348-1351. doi:10.1097/ACM.0000000000001347

• Advanced Practice Nursing Education Core Competencies for the Prevention and

Management of Prescription Drug Misuse http://www.mass.gov/eohhs/docs/dph/stop-

addiction/governors-advance-practice-nurse-practicioner-education-working-group-

prescription-drug-misuse-core-competencies.pdf

• Governor's Opioid Working Group, T. C. o. M. (2015). Recommendations of the

Governor's Opioid Working Group. Retrieved from

http://www.mass.gov/eohhs/docs/dph/stop-addiction/recommendations-of-the-

governors-opioid-working-group.pdf

ReferencesReferences

• American Psychiatric Association. (2016). Practice guidelines for the

psychiatric evaluation of adults (3rd ed.). Arlington, VA: American

Psychiatric Association.

• American Society of Addiction Medicine 2016 Facts and Figures.

Available at https://www.asam.org/docs/default-

source/advocacy/opioid-addiction-disease-facts-figures.pdf

• Broom, C., Shirk, M.J., Pehrson, K.M & Peterson, K. (2008).

Perspectives on psychiatric consultation liaison nursing. Perspectives in

Psychiatric Care, 44 (2), 131-134.

• Centers for Disease Control and Prevention (CDC), Opoid Overdose

(2017). Guidelines Resources: Clinical Tools. Retrieved from

https://www.cdc.gov/drugoverdose/prescribing/clinical-tools.html



• Drug Enforcement Administration (DEA), United States Department of

Justice, Diversion Control Division (2017). State Prescription Drug

Monitoring Programs. Retrieved from

https://www.deadiversion.usdoj.gov/faq/rx_monitor.htm

• Hammond, C., Mayes, L., Potenza, M. (2014) Neurobiology of

adolescent substance use and addictive behaviors: Prevention and

treatment implications, Adolescent Med State Art Rev, 25(1):15-32.

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