Given the typically meager amount of substance use-related training offered in medical school, a young physician generally can't qualify to prescribe buprenorphine for opioid dependence until well after completing formal schooling. That will be changing for graduating students at Brown University's Warren Alpert Medical School, who thanks to an innovative partnership with the state of Rhode Island will immediately be eligible to treat patients with buprenorphine.
These recipients of a Drug Abuse Treatment Act of 2000 (DATA 2000) waiver will have to practice in Rhode Island for the time being in order to qualify, but an organizer of the initiaitive hopes to see other states establish similar training programs or reciprocity arrangements that will allow these young doctors to become buprenorphine prescribers in other states as well.
In an interview this week with Addiction Professional, the Alpert Medical School's assistant dean for medical education outlined the recent history that brought the school to this important step.
Paul George, MD, explains that the school began to move toward expanded training hours in addictions as part of a joint federal grant application with two other Rhode Island educational institutions that focused on the growth of screening, brief intervention and referral to treatment (SBIRT) efforts.
Soon thereafter, members of the Governor's Overdose Prevention and Intervention Task Force in Rhode Island approached the medical school with interest in having students receive DATA training at a much earlier stage. The idea of incorporating the entire DATA 2000 waiver course into an already crowded medical school curriculum did not seem particularly appealing, but then the idea transitioned to determining whether the school's already growing substance use disorder training hours could in fact meet the DATA 2000 requirements.
The state Department of Behavioral Healthcare, Developmental Disabilities and Hospitals concluded that Brown's 23 hours of training across the medical school curriculum met that standard, and more than 30 members of next year's graduating class will therefore be able to prescribe buprenorphine in Rhode Island. The program ultimately will extend to the entire medical school class.
“Rhode Island is one of the states hit hardest by overdose deaths,” says George.
Shift in thinking
George recalls that when he graduated from medical school in 2005, he had received little training in opioid use disorders and minimal exposure to substance use topics in a family practice residency. “It wasn't an emphasis,” he says.
Doctors are trained to fix problems, he says, and have been frustrated that they haven't been able to apply the same kinds of interventions for substance use disorders as they have for illnesses such as hypertension. Stigma also has played a role, and George says much of the university's effort has focused on placing opioid use disorders on the same level as other treatable diseases.
He sees an evolution in thinking in the larger medical community. A recent free DATA 2000 training for practicing physicians in Rhode Island attracted more than 200 participants. “Back a number of years ago, you wouldn't have gotten 20 or 30 in that room,” George says.