Off the record: addictions in medical schools
“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.
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| photocredit: mrmediatraining.com |
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
General practice is a key route for distribution of naloxone in the community
Naloxone is an antidote to opioid overdose also known as Narcan.
Irish family doctors in training want Narcan to be more available and want to distribute it.
We poled 136 Irish family doctors attending a training conference. They were in their third and final years of residency.
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| photocredit: oxywatchdog.com |
We found that trainees have real experience of the problem at an early phase of their careers, and
trainees are conscious of the needs of people with opioid use disorders and the potential of family medicine to meet these needs, but trainees receive little structured preparation for this role.
Irish family doctors in training are keen to distribute Naloxone in the community.
More people die in Ireland due to opioid overdoses than in car accidents.
Naloxone can save lives. Ireland has approximately 640 doctors in specialist training for family medicine at any time. Although 60% of them have administered Naloxone to a person in overdose, only 13% of their training clinics prescribe methadone to people with opioid use disorders.
Reference:
Klimas, J., Tobin, H., Egan, M., Barry, T., Bury, G. (2016) General Practice – a key route for distribution of naloxone in the community. Experience, interest and training needs in Ireland. J Int Drug Policy, 38:1-3
What do persons on methadone in primary care think about alcohol screening?
Enhancing alcohol screening and brief intervention among people receiving opioid agonist treatment: Qualitative study in primary care
New Paper Out Now
Although very common, excessive drinking by people who also use other drugs is rarely studied by scientists. The purpose of this study was to find out patient’s and clinicians’ opinions about addressing this issue. All of them took part in a study called PINTA – Psychosocial interventions for problem alcohol use among problem drug users.
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| photocredit: emerald |
Doctors reported obstacles to addressing heavy drinking and overlooking and underestimating this problem in this population.
Patients revealed that their drinking was rarely spoken about and feared that their methadone would be withheld.
Read the full article in the latest issue of the Drugs and Alcohol Today: http://www.emeraldinsight.com/loi/dat
See also my previous posts about the PINTA study:
New paper out now: Psychosocial Interventions for Alcohol use among problem drug users
2014
Beg, steel or borrow: getting physicians to recruit patients in clinical trials
Addiction Medicine Education for Healthcare Improvement Initiatives: New Paper out Now
2013
Honor pot: testing doctors’ drug counselling skills in a new pilot study in Ireland
Fidelity questions
Why Empirically Supported Psychosocial Treatments Are Important for Drug Users? New research project
Recipe for untangling complex healthcare
Physicians tackle difficult addictions
Recipe for untangling complex healthcare.
So there he was, with the boy’s head in his hands. The boy was 12, but looked no more than 10 years old. He was deeply jaundiced and in a heroin withdrawal. It was 1981; Fergus O’Kelly was a family physician in the inner city Dublin, Ireland.
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| photocredit: journals.cambridge.org |
Complex interventions are best fashioned in stages, says the Medical Research Council in the U.K. They came up with a 6-step recipe for untangling complex health interventions. The recipe can help those of us who are researchers define their interventions and evaluate their implementation.
Substance use disorder treatment is a complex problem. Complex problems require complex interventions, ideally tested via randomised controlled trials.
Complex interventions are best developed in stages, using established implementation frameworks.
Starting with a historical patient case study, we explore how treatment of this challenging population group has been approached, how an evidence-based framework has informed formulation of a complex health intervention and how this has been progressed via the UK’s Medical Research Council (MRC) approach.
Read the paper in the December 2018 issue of the Irish Journal of Psychological Medicine:
Klimas, J. (2018). General practitioners tackle complex addictions: How complex interventions can assist in dealing with addiction. Irish Journal of Psychological Medicine, 35(4), 329-331. doi:10.1017/ipm.2016.30
http://journals.cambridge.org/action/displayIssue?jid=IPM&tab=firstview
The paper was first published online in August 2016.
The case study of the boy mentioned at the beginning was published in 1986 in this paper: Ryan, WJ, Arthurs, Y, Kelly, MG, Fielding, JF (1982). Heroin abuse with hepatitis b virus associated chronic active hepatitis in a twelve-year-old child: a non-fictitious pulitzer prize. Irish Medical Journal 75, 166. Google Scholar
Read the full text of the case here: https://core.ac.uk/download/pdf/34711593.pdf
Finally, if you enjoyed reading this post, you can also read more about complex problems here:
Users voices: Are drug problems too complex and dynamic for single magic bullet solutions?
New paper out now: Primary care distributes life-saving medication for 17 years
The year was 1996 and Ireland was recovering from a recent heroin epidemic. Methadone, a medical replacement drug for heroin, was jut making its way into specialised clinics in Dublin.
Professor Gerard Bury and colleagues had a revolutionary idea that people who use drugs can receive agonist drugs, like methadone, from their family doctors.
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| photocredit: tandfonline.com/loi/igen20#.VlO9bHarTrc |
The opioid agonist treatment has substantially changed the course of the drug use epidemic. Yet, many continue to die and suffer from chronic diseases. In Ireland, everybody who’s prescribed this medication has to be registered with the Central Treatment List.
In this new study, we wanted to revisit a group of people who were the first to receive their agonist medication, i.e., methadone in the primary care in Ireland.
At follow-up in 2013, 27 (27.6%) of the 98 people had died in Ireland and had relevant entries in the Register of Deaths, 19 (19.4%) were currently in OAT and the status of the remaining 52 (53%) was ‘alive,’ as per the Irish death registry.
The 52 patients ‘alive’ had left the Central Treatment List, but no further information was available on their status.
“Our inability to establish the interval data for the retention in treatment is a significant study limitation, but the overall retention of 19 out of the surviving 71 patients is comparable to previous research.”
The deceased died of multiple causes; only six had a single cause. Drug toxicity, overdose, or both, were the most common causes of death.
Cited study:
Jan Klimas, Anna Keane, Walter Cullen, Fergus O’Kelly, and Gerard Bury (2015) Seventeen year mortality in a cohort of patients attending opioid agonist treatment in Ireland. European Journal of General Practice (http://dx.doi.org/10.3109/13814788.2015.1109076)