By the University at Buffalo
The University at Buffalo and Erie County are joining forces to develop a comprehensive approach to fight Western New York's opioid abuse epidemic.
In 2015, the number of deaths from opiate overdoses in Erie County skyrocketed. The county estimates that, once the data are complete, the number of overdose deaths from opiates may more than double, from 128 deaths in 2014 to nearly 280.
"The spike in overdose deaths this year points to the need for major institutions in the community to come together to address the problem," said Gale Burstein, M.D., Erie County commissioner of health.
"UB is the only institution in Western New York that educates health care providers of every type," she said. "It trains our physicians, dentists, nurses, nurse practitioners, pharmacists, social workers and public health professionals. UB can be the role model for health care providers in the community on how to safely deal with acute and chronic pain, and how to recognize and treat opiate addiction."
Michael Cain, M.D., vice president for health sciences and dean of the Jacobs School of Medicine and Biomedical Sciences at UB, agreed.
"UB is in a unique position to effect positive change in terms of safe prescribing practices since we train so many of the region's health care providers, graduating more than 600 new health care professionals every year," he said. "Our interprofessional focus, where we train students in all six health sciences schools to work with each other on multidisciplinary teams, is ideally suited to addressing this public health crisis."
In October, the Tower Foundation awarded a $64,500 grant to the county to develop guidelines for health care providers on safe prescribing practices and training for safe pain management, and how to screen and manage opioid addicts. The UB-Erie County partnership will leverage these efforts with a multidisciplinary approach focused on training current and future health care providers in safe acute-pain management. The partnership will work to educate providers, patients and the community about the risks of opioid pain medications and how quickly addiction and, subsequently, even fatalities, can occur when opiates are prescribed - even for legitimate reasons.
The effort will involve UB's health sciences schools - the Jacobs School of Medicine and Biomedical Sciences, the School of Dental Medicine, the School of Nursing, the School of Pharmacy and Pharmaceutical Sciences and the School of Public Health and Health Professions - as well as the School of Social Work. The UB Law School and the School of Management are adjunct participants.
The partnership also takes advantage of resources at the university that have long been involved in exploring the origins and impact of addiction, such as UB's Research Institute on Addictions (RIA), a national leader in the study of substance use and abuse. According to Ken Leonard, director, the RIA has pioneered studies in the neurobiology, the causes and consequences, and the treatment of addictions.
"RIA will help the university develop a comprehensive framework for education in addiction, based on current course offerings, as well as new ones under development, at the undergraduate and graduate levels, in addition to supporting graduate degrees, concentrations and certificate programs in disciplines that commonly address addiction-related issues," he said.
In the Jacobs School of Medicine and Biomedical Sciences, efforts are underway to enrich the curricula of medical residents who care for patients who are addicted or are at risk for addiction.
"Residency education is going to build on its existing practice of training residents to screen for, and properly manage, patients with substance abuse and related issues that affect patients and their families," Cain said.
Efforts are ongoing to recruit residents into fellowships that focus on pain and addiction who will then continue as faculty with expertise to educate and provide much needed care, according to Roseanne Berger, M.D., senior associate dean for graduate medical education.
"UB sponsors fellowships in pain medicine, hospice and palliative care and, in addiction, medicine," she added. "These fellowships build on the education included in the core residency years, which will be enriched by the collaborations with RIA and others."
Paul Wietig, Ed.D., assistant vice president in the UB office of interprofessional education, is coordinating the effort.
"UB is making a major contribution to educating our health sciences students, as well as providers in the community, so that they can prevent, recognize and treat opiate addiction," he said.
The effort also will focus on empowering students in UB's health sciences schools to help disseminate public health messages to their peers about the dangers of opiates.
Expertise Across Disciplines
Throughout UB, faculty members are developing new instructional materials that emphasize safe prescribing practices. Karl Fiebelkorn, senior associate dean for student, professional and community affairs in the School of Pharmacy and Pharmaceutical Sciences, educates students about opioid abuse and works with county officials to train students to administer Narcan, a medication that reverses overdoses.
Part of this new curriculum will include educating students about how opiate addiction develops, especially in young patients.
"High school students do not one day decide to start injecting heroin," Fiebelkorn said. "It might start with an opioid prescription for a legitimate injury or finding grandma's pain pills in her medicine cabinet. Once they get hooked, they want more. If they can't get more pills, they end up mixing with the wrong people and buying heroin."
Pain medications prescribed for legitimate injuries are an important risk factor, Burstein noted. A recent paper published in Pediatrics reported the risk of developing an opiate addiction after high school is three times higher for high school students who disapprove of illegal drug use who are then prescribed pain pills for a legitimate injury, often sports-related.
Specific departments at UB have developed nationally recognized expertise in treating patients with substance abuse problems. Faculty in the department of family medicine directs the National Center for Physician Training in Addiction Medicine. Richard Blondell, M.D., heads the effort, developing national curricula and guidelines for the nation's graduate medical education programs in addiction medicine, while also teaching UB medical students and current practitioners about preventing and treating addiction.
The department, which has three full-time addiction physicians, also administers UB's fellowship in addiction medicine, funded by the Erie County Medical Center. Under Blondell's direction, UBMD Family Medicine, one of the clinical practice plans of the medical school, runs an addiction medicine practice out of an office in Amherst.
"There's a patient care imbalance," Blondell said. "Physicians write a large number of scripts for pain, and then some patients become addicted, but there is a very limited number of addiction physicians who can treat them."
Fighting an epidemic on multiple fronts
UB faculty will work with the county to develop local guidelines for safe pain management and hold continuing medical education workshops to teach providers how to address pain while minimizing the prescribing of opioids.
They note many physicians were trained in an era when they were reprimanded if they weren't addressing patient pain with the most powerful narcotics. The result, they said, is a culture where there may be no tolerance for even a little pain.
Patients also need to be educated.
"Just because you're offered a pain medication prescription, doesn't mean you have to take it," Burstein said.
Founded in 1846, the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo is beginning a new chapter in its history with the largest medical education building under construction in the nation. The eight-story, 628,000-square-foot facility is scheduled to open in 2017. The new location puts medical education, clinical care and research in close proximity, anchoring Buffalo's evolving comprehensive academic health center in a vibrant downtown setting. These new facilities will better enable the school to advance health and wellness across the life span for the people of New York and the world through research, clinical care and the education of tomorrow's leaders in health care and biomedical sciences.
The school's faculty and residents provide care for the community's diverse populations through strong clinical partnerships and the school's practice plan, UBMD.