D.C. Stokes is a fourth-year medical student and research fellow, Center for Emergency Care Policy and Research, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; ORCID: https://orcid.org/0000-0002-9622-2761 .
J. Perrone is founding director, Penn Medicine Center for Addiction Medicine and Policy, and professor, Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
Acad Med. 2022 Feb 1;97(2):182-187. doi: 10.1097/ACM.0000000000003968.
In the face of an ongoing opioid crisis in the United States, persistent treatment gaps exist for vulnerable populations. Among the 3 Food and Drug Administration-approved medications used to treat opioid use disorder, many patients prefer buprenorphine. But physicians are currently required to register with the Drug Enforcement Administration and complete 8 hours of qualifying training before they can receive a waiver to prescribe buprenorphine to their patients. In this article, the authors summarize the evolution of buprenorphine waiver training in undergraduate medical education and outline 2 potential paths to increase buprenorphine treatment capacity going forward: the curriculum change approach and the training module approach. As part of the 2018 Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act, the Substance Abuse and Mental Health Services Administration has provided funding for medical schools to adapt their curricula to meet waiver training requirements. To date, however, only one school has had its curriculum approved for this purpose. Additionally, recent political efforts have been directed at eliminating aspects of the waiver training requirement and creating a more direct path to integrating waiver qualification into undergraduate medical education (UME). Other medical schools have adopted a more pragmatic approach involving the integration of existing online, in-person, and hybrid waiver-qualifying training modules into the curricula, generally for fourth-year students. This training module approach can be more rapidly, broadly, and cost-effectively implemented than the curriculum change approach. It can also be easily integrated into the online medical curricula that schools developed in response to the COVID-19 pandemic. Ultimately both curricular changes and support for student completion of existing training modules should be pursued in concert, but focus should not be single-mindedly on the former at the expense of the latter.
面对美国持续存在的阿片类药物危机，弱势人群的治疗缺口依然存在。在美国食品和药物管理局批准的用于治疗阿片类药物使用障碍的 3 种药物中，许多患者更喜欢丁丙诺啡。但是，医生目前必须在药物管制局登记，并完成 8 小时的合格培训，才能获得为患者开丁丙诺啡的豁免权。在这篇文章中，作者总结了本科医学教育中丁丙诺啡豁免培训的演变，并概述了增加丁丙诺啡治疗能力的 2 种潜在途径：课程变更方法和培训模块方法。作为 2018 年《促进患者和社区阿片类药物使用障碍预防康复治疗法案》的一部分，物质滥用和精神健康服务管理局为医学院提供了资金，以调整其课程以满足豁免培训要求。然而，迄今为止，只有一所学校的课程获得了批准。此外，最近的政治努力一直致力于消除豁免培训要求的某些方面，并为将豁免资格纳入本科医学教育（UME）创造更直接的途径。其他医学院则采取了更务实的方法，将现有的在线、面对面和混合豁免资格培训模块纳入课程，通常是针对四年级学生。这种培训模块方法比课程变更方法更快速、广泛且具有成本效益。它还可以轻松整合到学校为应对 COVID-19 大流行而开发的在线医学课程中。最终，课程变更和支持学生完成现有培训模块都应该同时进行，但重点不应仅仅放在前者上，而忽视后者。
