Medical residents battle opioid epidemic in Massachusetts

Troy Parks
Staff Writer
AMA Wire
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Amidst the national opioid epidemic, resident physicians in Massachusetts have taken matters into their own hands to improve public health and promote safe prescribing in their state. Learn how they gained access to a critical tool and put themselves in a better position to reduce prescription opioid misuse and provide more informed care to their patients.

Accessing the state’s prescribing database

In Massachusetts, the state’s prescription drug monitoring program (PDMP), an electronic database that physicians can consult to learn, among other things, patients’ controlled substance histories, has been in place since 1992. Although several major teaching hospitals exist in the Boston area alone, resident physicians have never had access to this database to check their patient’s prescription history before prescribing opioids.

That is, until last December when two resident organizations came together and created a plan to gain access to their state PDMP through regulatory action.

“Over the past couple months, it’s been a whirlwind of advocacy that ended in us getting access [to the PDMP],” said Grayson Armstrong, MD, an ophthalmology resident at Harvard Medical school and a leader within the Cambridge Health Alliance union, known as the Committee on Interns and Residents–Service Employees International Union. “Residents can [now] take an active role in managing and controlling the nation’s prescription opioid epidemic.”

Why access is so important for resident physicians

“Prior to this change, residents were lacking one critical tool to inform our prescribing,” Dr. Armstrong said. “We were often in the dark in regards to a patient’s prior opioid prescription history. Now, we can be more confident in our decision to prescribe or withhold opioids.”

Before gaining the authority to access the state PDMP, residents had to find an attending physician to check the PDMP for them when they had a patient who might require a prescription for a controlled substance.

“The question used to come up all the time,” Dr. Armstrong said, “Should we check the PDMP? Is it worth the hassle of finding an attending who is willing to spend 15 minutes of their day trying to log in on our behalf? Or do we just trust this patient and give them opiates?”

“Now, it’s going to completely revolutionize the way we approach this problem,” he said. “We can actually get a better grasp on whether this person has been prescribed opiates recently or in the past year, how many, when and by whom. I think it’s going to change a lot.”

How they did it

Cambridge Health Alliance’s resident union “recently hired an incredible new member organizer, Melissa Markstrom, who listened when residents raised the opioid epidemic as a major topic of interest,” Dr. Armstrong said. “When I suggested we fight to get residents access to the PDMP, she took it and ran with it.”

The union then created and circulated a petition requesting access for residents to the PDMP that garnered almost 300 signatures of medical students, residents and attending physicians from throughout the state.

The Massachusetts Medical Society also was involved. “At their most recent state-wide meeting,” Dr. Armstrong said, “I presented members with the petition, and a large number of doctors signed on. Then the petition was sent to Gov. Charlie Baker.”

“We had a chance to go to a forum where the governor was speaking on the opioid crisis in Massachusetts and spoke with him there,” he said. “I told him that residents didn’t have access to this, and he wasn’t aware of this issue prior to that day. As soon as he was aware, everyone else got on board with it …. It was a relatively quick change.”

5 ways residents can help reduce prescription opioid overdose

The AMA’s Task Force to Reduce Prescription Opioid Abuse, made up of representatives from more than 25 health care associations, recommends five steps all physicians—including residents—should take to curb the epidemic.

  • Register for and use your state PDMP - “I’m excited that now a huge portion of the prescribers in the state of Massachusetts will have access where they didn’t before,” Dr. Armstrong said. “Physicians and residents are the gatekeepers of the health care system’s resources, and it is important that we use these resources judiciously.” Learn more about how to register for and use your state’s PDMP. Residents in a few states still don’t have access to PDMPs.
  • Enhance your education on effective, evidence-based prescribing - “It all boils down to education,” Dr. Armstrong said. “Residents can start by ensuring that they are educated and informed about the benefits and risks of opiate medications. Medical schools may or may not have taught current residents about pain management. If that training wasn’t provided, residents should take it upon themselves to learn all they can about appropriate prescribing of opiates.” 
  • Expand access to naloxone in the community and through co-prescribing - Medical residents in Massachusetts aren’t finished with their work in moving their state toward reversing the nation’s opioid epidemic. We want now to “increase the number of naloxone and other prescribers at our hospital to try to give more residents access … by providing the treatments that [the local community] needs,” Dr. Armstrong said. Find out whether your state has enacted measures to increase the use of naloxone and learn more about co-prescribing naloxone with this guide (log in) compiled by the AMA Task Force.
  • Reduce the stigma of pain and promote comprehensive assessment and treatment - It’s important to reduce the stigma that surrounds pain patients in order for those with chronic pain to receive the care and the prescriptions they need to live happier, healthier lives.
  • Reduce the stigma of substance use disorder and expand access to comprehensive treatment - Residents should “be cognizant that addiction is a disease and needs treatment,” Dr. Armstrong said. “If you are seeing a patient that you think might be suffering from opiate addiction, you should do all you can to connect those individuals to appropriate care.” 

Learn more about substance use disorder and steps you can take to help patients with this condition.

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Medical school
Oct 27, 2016
Medical education is hugely expensive. Are students getting good value for their investment? One school looks at evaluating what they spend on education and what actually has the highest impact.