In recent years, opioid overdoses have surpassed auto accidents as the leading cause of accidental death for adults in the United States, according to the U.S. Centers for Disease Control.
One of the major hurdles to providing treatment for opioid use is a lack of doctors and nurses trained to treat it, since health professionals must take additional classes to prescribe certain medicines.
Physicians must take an eight-hour course and nurse practitioners 24 hours of training to legally prescribe a drug called buprenorphine (known by numerous trade names including Subutex), an opioid used to treat addiction. Both courses are available online, but for practitioners already working in the field, finding time for the required outside education can be a challenge.
“We said, ‘Let’s catch them while they’re still in school and show them state-of-the-art-treatment for opioid use disorder,’” said Scott Steiger, MD, an associate professor of Medicine at UC San Francisco.
Pulling Together Disciplines
Steiger, along with several colleagues from the School of Nursing, created a course called “Inter-Professional Approach to the Treatment of Opioid Use Disorder” which is supported by grant funding from the Substance Abuse and Mental Health Services Administration (SAMHSA).
Because UCSF trains so many leaders in the medical and nursing fields, we can mint these people who, down the line, will be leading clinics and organizations.
“Because UCSF trains so many leaders in the medical and nursing fields”, Steiger said, “we can mint these people who, down the line, will be leading clinics and organizations. And when they encounter a patient dealing with opioid use disorder, they’ll be able to treat that person right then and there.”
Nursing professors Elizabeth Gatewood, DNP, RN, FNP, and Matt Tierney, MS, NP, FAAN, had already been talking about putting together a course for nursing students when they saw the call for proposals from SAMHSA. They invited Steiger to help them develop the course. “We thought it would be great to make it interprofessional because we’re treating this condition in an interprofessional setting,” said Gatewood.
The course is structured in part in a “journal club” style, said Gatewood. Students meet for four-hour sessions, spending the first 90 minutes in lecture, and then break into small groups for the remainder of the time to discuss articles and cases. The small groups allow for cross-pollination between the medical and nursing students.
Hands-On Experience in Clinics
First offered in the spring of last year, the class also provides students with four-hour rotations at clinics throughout San Francisco and beyond – giving them hands-on experience related to addiction medicine.
The four colleagues have forged relationships with numerous clinical providers, such as the San Francisco Department of Public Health’s Street Medicine program, the BAART Clinic and others. They found that many clinicians from across the professional spectrum were eager to open their doors and welcome students for rotations, and to participate in the course in other ways, even giving pro bono lectures.
“I’ve never been in a situation before where there were so many providers from so many different professions contributing to the conversation as well as the lecture,” said Gatewood.
Tierney says clinicians are very enthusiastic about participating in the course, because the treatment is so rewarding. “There are so few treatments in modern health care where you see such an amazing favorable response from patients,” he said. “When you see a patient who is in opiate withdrawal and feeling despondent, it’s just so rewarding when you administer an initial dose of buprenorphine. The patient just feels better.”
The course’s first round of nursing students have graduated and faculty are eager to see how they incorporate this training into their clinical practice. “Hopefully, they’re going to be trailblazers,” Gatewood said.
“These students are really entering the field with an understanding that's different from my generation”, added Tierney. He feels that the interprofessional and clinical approach to this course, which will return in the spring, helps to set practitioners up for success.
“It’s really exciting to see students from different fields interact and learn from each other,” he said, “because no single profession is going to tackle the problems of opioid use disorder alone.”