The Doctor’s Dilemma

published on April 13, 2016 by Darrell G. Kirch, M.D., in Huffingtonpost

“First, do no harm.” As we weigh the strategies for tackling the opioid epidemic, I have been asking myself how we, as physicians and educators, can best honor that primary ethical commitment in a situation where there are no easy answers. As a psychiatrist, I have seen well-managed pain medication bring immense relief to patients suffering from debilitating pain. But I have also seen lives destroyed by opioid abuse, addiction, and overdose. How do physicians find the right balance between providing treatment and preventing abuse?

The statistics are staggering. More Americans now die from overdoses every year than in motor vehicle crashes. A majority of these overdoses involve prescription medications. Heroin-related overdoses nearly doubled between 2011 and 2013, and four in five heroin users started out by misusing prescription pain medication. This has become a full-blown public health crisis. As health care anchors in their communities, America’s medical schools and teaching hospitals see the impact of this crisis every day.

In education, research, and care, academic medicine is constantly evolving to keep pace with public health challenges and meet the needs of patients and communities. Nowhere is this more evident than in the current opioid epidemic. Nationwide, medical schools are building on existing substance abuse and pain management content that is part of required and elective coursework at nearly all U.S. medical schools. Medical schools augment lectures with a variety of hands-on instructional methods, such as simulated patient exercises, case-based instruction, workshop assessments, and clinical experiences. This strategy of weaving content throughout all four years of medical school strengthens knowledge retention. As they move into residency training, learners continue to work directly with patients to treat pain and learn the best practices for safely prescribing pain medication, especially opioids.

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