Our training program, the Spectrum of Pain and Addiction Scholarly Program, includes Drug Enforcement Administration X-waive (DEA-X) certification to prescribe medications used to manage opioid use disorder. The program aims to address the opioid crisis from the start by giving Wake Forest School of Medicine graduates the tools necessary to handle the addiction and pain management issues they will face as they enter practice.
Responding to student needs
The school’s Spectrum of Pain and Addiction Student Group and other students, who asked for additional training in pain medicine, particularly opioid stewardship and opioid therapy management led founding of the scholarly program.
“We take great pride in the innovative initiatives of our medical student interest groups,” said Peter Fuerst, PhD, professor of biochemistry and faculty director of the Programs of Distinction. “The Spectrum of Pain and Addiction Student Group saw a need and crafted a mechanism to become ‘Agents of Change’. These Wake Forest School of Medicine graduates are now influencing prescribing practices of their fellow residents and supervising faculty within their residency training programs not only in North Carolina but across the country. Our Wake Forest alumni make us proud!”
The program is administered through a unique combination of online modules and in-person workshops that give students a chance to ask questions and listen to the experiences of clinicians. Students are divided into subspecialty areas so that they can learn how pain medicine and opioid use disorder affects their area specifically.
“This approach helps give students in any specialty the confidence to deal with a complex pain issue on their own,” said Molly Jacobs, an MD student who helped develop the program curriculum.“ It also provides them with the competency to recognize a patient who might need help with, or be at risk for, addiction. They can take the first steps to intervene and engage the resources and providers necessary to help that patient.”
Making an impact
A recent study looked at the program’s feasibility and impact. It found that not only did participants believe that the training was worth their time, more than 60% of the first-year residents felt as prepared or more prepared to treat opioid use disorder than their fellow residents.
“In addition, almost 20% felt more prepared than their supervising faculty, which is pretty stunning,” said Paige Estave, an MD-PhD graduate student and first author of the study. “This speaks to their potential as change agents and shows that they are likely confident to talk to their supervising faculty about different options. For example, they might suggest prescribing buprenorphine for a patient struggling with opioid use disorder or trying Tylenol for pain before prescribing an opioid.
Shane Stone, MD, a Physical Medicine and Rehabilitation Resident with McGaw Health at the Shirley Ryan Ability Lab in Chicago was part of the first class to complete the training in 2019 and also helped develop the program.
“The training dispelled a lot of misconceptions I had about using buprenorphine to manage opioid use disorder,” said Stone. “Throughout my medical school career, I had informally consulted a faculty member to help me convince providers to start buprenorphine. After the program, I felt less dependent on her and more confident in my own ability to talk to patients and colleagues about it.”
Estave points out that the program also plays an important role in decreasing the stigma around substance use by reminding students that it is a brain disease and helping them spot at-risk patients.
“Retraining every provider when decades of habits have been formed is really challenging,” says Roy Strowd, MD, MEd, MS, Professor and Interim Chair of the Neurology Department. “We were very delighted to find that interns are using their knowledge to influence the residents, faculty, and others around them, because that's how we'll actually make a difference with opioid prescribing at large.”
Spreading the word
Stone is helping to make a difference by teaching others what he learned through the training program. He recently gave a presentation about buprenorphine to the entire Shirley Ryan Ability Lab residency program. After the presentation, some residents expressed interest in pursuing their own DEA-X certification.
“I also used the training as a springboard to learn more about medications that can be used in other forms of addiction,” said Stone. “Throughout my intern year, I started patients on FDA-approved medications for other addictions and educated attending physicians on this so that they would feel comfortable doing the same.”
“Every provider will encounter a patient who is dealing with, recovering from, or denying their addiction,” said Stone. “If we can make even the smallest difference in helping them on their recovery journey, we should. However, providers that don’t have the knowledge and tools necessary to guide them may miss important opportunities to help.”
Programs of Distinction at Wake Forest University School of Medicine allow students to personalize their educational experience, develop special interests and demonstrate outstanding motivation to residency selection committees.