A 21 y/o has surgery for a condition expected to improve. He fills a discharge prescription for 5 days of an opioid at a standard dose. At 1-week follow-up with his family doctor for suture removal, he describes ongoing pain. Can prescribers avoid contributing to opioid use disorder? Is a renewal of opioid appropriate, potentially dangerous, or both? Read more …
Can prescribers avoid contributing to opioid use disorder?
What are the training needs of newly trained professionals working in addiction medicine around the world? Do they get enough and appropriate training to treat people who live with addictions? A new study protocol plans to answer these questions. (more…)
“If it’s not recorded, it didn’t happen.”
– An old saying
We wanted to find out how much teaching on addiction get on medical students. In 2011, our colleagues Sarah O’Brien and Professor Cullen searched PubMed (online database of medical papers) for published literature on training of undergraduate medical students in addiction
There is currently no documentation of drug addiction teaching sessions in Irish medical schools.
We looked at other medical databases and we also searched websites of all 6 medical schools in Ireland. We have searched the literature published after October 2009.
We found nothing in the medical databases. Schools’ homepages did not mention addiction either.
A telephone survey may provide a more accurate representation of how addiction medicine education is incorporated into the medical school curricula.
Substance use disorders are a worldwide problem, and have become a major health concern in Ireland particularly.
In their new position paper on addiction, the Irish Medical Organisation recognized the lacking education and called for “appropriate training of all physicians in treatment of addiction” (Irish Medical Organisation, 2015). Although the science behind addiction treatment has discovered new treatments for addiction, the medical doctors don’t know about them, mainly because they get no training on addiction. As a result, they feel unprepared to treat people with addiction who receive inadequate care.
To cite this article: Mitch Wilson, Walter Cullen, Christine Goodair & Jan Klimas (2016): Off the record: Substance-related disorders in the undergraduate medical curricula in Ireland. Journal of Substance Use, DOI: 10.3109/14659891.2015.1112853
How should primary care doctors ask their methadone patients about alcohol use?
We worked with 13 primary care doctors and divided them into two groups. We trained one group on how to ask about and advise on heavy drinking. We looked at whether trained and coached doctors managed patients who drank.
Primary care can look at drinking among persons on methadone treatment and advise on risks of heavy drinking.
We found that the trained doctors asked about and advised on heavy drinking more often than the untrained doctors. Four patients in their care drank less alcohol three months later, compared to two patients of the untrained doctors. Some doctors were reluctant to use their new learning in the practice because it was too complicated.
A bigger and simpler study must prove the positive results of this modest study
Methadone helps people with opioid use disorders use less drugs, but it doesn’t stop them from drinking. About 30% of them drink in excess of the low-risk drinking limits. Drinking makes their treatment harder and their health worse. Primary care doctors who prescribe methadone see patients weekly and can help them drink less.
Reference: Henihan, AM., McCombe, G., Klimas, J., Swan, D., Leahy, D….Cullen, W. (2016) Feasibility of Alcohol Screening among Patients receiving Opioid Agonist Treatment in Primary Care. BMC Family Practice, 17:153