November 8, 2020

Study examines incoming medical student knowledge of opioid overdoses and substance use disorders

Tabitha Moses, May Chammaa and Rafael Ramos
From left are Tabitha Moses, May Chammaa and Rafael Ramos.

Three students at the Wayne State University School of Medicine led a new study now in press that reveals incoming medical students have greater opioid overdose knowledge than the general population, but still harbor significant misinformation and stigma toward patients with substance use disorders.

Tabitha Moses, May Chammaa and Rafael Ramos, are members of Detroit vs. Addiction, one of more than 70 student organizations medical students can join. Detroit vs. Addiction provides education to medical students regarding addiction, giving students the opportunity to provide holistic and non-judgmental care for people struggling with substance use disorders. Its overall mission is to encourage the initiation and maintenance of opioid addiction treatment by equipping the community with readily available resources. By working together with other health professionals throughout the community, they hope to improve the lives of those struggling with addiction.

The resulting paper, “Incoming medical students’ knowledge of and attitudes toward people with substance use disorders: implications for curricular training,” has been accepted for publication in Substance Abuse, the journal of the Association for Multidisciplinary Education and Research in Substance Use and Addiction.

More than half of students knew someone with a substance use disorder, and one-quarter knew someone who had overdosed on drugs. One surprising finding in the study is that students who had previously worked in health care knew less about opioid overdose response than those who had not; however, more of the students who had worked in health care believed that they had the knowledge and skills necessary to respond to an opioid overdose.

“We had expected that people who had previous health care experience would know more, not less, than those who had not. We think that this result is indicative of just how pervasive stigma, bias and misunderstanding is around substance use disorders and overdose, and it is likely that students gained this misinformation during their clinical experiences,” said Moses, an M.D./Ph.D. student. “These findings show the necessity of providing a foundation of basic information about these issues to all students regardless of previous training experiences and importantly also demonstrate a desire for this training as 94.4% of students stated that they wanted to improve their knowledge and understanding of these topics.”

In 2019, the group conducted a small pilot study across all classes to gauge student interest in receiving more training on substance use disorders and opioid overdose prevention. The results of that study suggested there was significant interest. They are now working to incorporate new training sessions into the pre-clerkship curriculum, including Opioid Overdose Prevention and Response Training.

“We believe that it is important not just to add new content to the curriculum but also to follow its effects and confirm that it is beneficial,” Moses said. “As part of this larger, longitudinal project, we wanted to learn more about the baseline knowledge about and attitudes toward opioid overdose and substance use disorders in incoming medical students. This knowledge will allow us to ensure that the curricular changes are appropriately designed for the needs of the students.” 

Substance use disorders affect everyone in some way, M.D./Ph.D. student Ramos added, including physicians, regardless of specialty, who will encounter patients with substance use disorders.

“We believe this education should be incorporated at all levels of training and across all specialties. Education on substance use disorders should not just be about the physiology behind drug use and treatments, but should also focus on the patients and their stories and the barriers that they face when seeking care,” Ramos said. “There is a lot of stigma surrounding substance use disorders, and we need our curriculum to include more patient experiences to help reduce stigma toward these patient populations and allow us as physicians-in-training to know how to best meet patients where they are.”

Professor of Psychiatry and Behavioral Neurosciences Mark Greenwald, Ph.D., the Gertrude Levin Endowed Chair in Addiction and Pain Biology, and Assistant Professor of Psychiatry and Behavioral Neurosciences Eva Waineo, M.D. ’05, who leads the department’s medical education efforts, mentored the students. The study is part of a larger project looking to evaluate the needs for substance use education in medical school and the efficacy of certain educational interventions.

“These baseline findings can be used to tailor didactic efforts, starting early in medical school, so that graduating physicians can be adequately prepared for clinical care,” Dr. Greenwald said. “Results of these didactic efforts, to be described in several papers in preparation, have led to opioid overdose prevention and response training becoming a standard part of the WSU medical school curriculum.”

Dr. Waineo, teaming with the Curriculum Task Force, has been a major advocate for providing substance use disorder education and outreach opportunities for School of Medicine students. Previously, there was very little education on substance use disorders, and only primarily during psychiatry units, the students said.

WSU School of Medicine students pride themselves on community service and the role they play in community-based clinics as well, medical student Chammaa said.

“As students, we may be volunteering in these clinics from our first year, so it’s important that we have some basic knowledge on substance use disorders and overdose prevention so that we can help our patients,” she added. “The integration of trainings on naloxone use and opioid overdose prevention and response at the beginning of the first year is a fantastic step forward. The next step will be to find ways to reduce negative attitudes and stigma toward these patients and to address myths surrounding substance use and harm reduction. As students, many of us have heard biased or misinformed comments about patients with substance use disorders from physicians we are working with. I hope that through this larger project we can help develop the next generation of physicians who are well-informed about these issues and able to treat all patients, including those with substance use disorders, with respect.”