Abstract
Context:
Recreational use of opioids is a growing problem in the United States, particularly in the Midwest. Educators have called for inclusion of pain- and opioid-specific courses in health professional school curricula, yet more research is needed to address future prescribers’ beliefs, experiences, and postgraduate plans related to opioids.
Objective:
To examine health professional students’ perceived severity of the opioid crisis and opioid-related beliefs, experiences, and postgraduate plans.
Methods:
Using a descriptive, cross-sectional design, researchers evaluated health professional students from 3 academic programs (nurse practitioner [NP], physician assistant [PA], and doctor of osteopathic medicine [DO]) using a 25-item survey that assessed perceived opioid crisis severity and opioid-related beliefs, experiences, and postgraduate plans. Demographics of respondents were assessed using descriptive statistics and frequencies. Responses were compared between academic programs with 1-way analysis of variance or Kruskal-Wallis tests, and relationships between students’ experiences and postgraduate plans were assessed.
Results:
A total of 491 students (mean [SD] age, 27.2 [5.4] years; 62.7% female; 68.2% DO students) participated in the survey (response rate, 40.4%). The opioid crisis was perceived to be severely impacting the health care system (mean [SD] score, 79.7 [16.8] out of 100), and most respondents (415 [84.5%]) reported that opioid use affected their communities. Clinical experience varied by program, with NP students (75 [81.5%]) reporting the most experience treating acute overdose. Most respondents (317 [64.6%]) agreed that their postgraduate practice would involve caring for patients addicted to opioids; however, only 232 students (47.3%) felt confident in their ability to treat patients with addiction. Experiences managing acute overdose and handling drug-seeking behavior were positively associated with a belief that postgraduate work would involve working with patients with addiction (U=38,275.5, Z=5.92, P<.001; U=25,346.0, Z=4.94, P<.001) and confidence in treating patients with opioid addictions (U=36,806.5, Z=4.96, P<.001; U=23,765.5, Z=3.66, P<.001).
Conclusion:
Although health professional students had similar beliefs and perceptions regarding the opioid crisis, there were notable differences between academic programs. Students with clinical opioid experiences were more likely to plan on working with patients addicted to opioids and be confident in treating these patients. Thus, the inclusion of experiential learning in the medical curricula may be beneficial for both students and their future patients.
Recreational opioid use has increased dramatically in the United States. When opioids are prescribed for chronic pain, rates of prescription opioid misuse range from 21% to 29%, while rates of addiction are much lower, ranging from 8% to 12%.
1 The rise in prescription abuse has been accompanied by increased heroin use.
2 A 2016 study found that 7.5% of people who misused illicit prescription opioids transitioned to heroin.
3 Although this transition rate remains fairly low, those who use heroin are more likely to have misused prescription opioids in the past.
4 Additionally, recreational use of opioids has resulted in a steep increase in opioid-related overdose deaths across the country, especially in Midwestern states. This rise in deaths has been attributed to the increased use of synthetic opioids like fentanyl.
5
Although the opioid crisis is a relatively recent and unique public health problem, addiction and substance abuse are not new issues that health professional students will have to contend with. Previous studies have documented that medical students and residents hold negative attitudes toward tobacco and alcohol addiction, specifically toward the efficacy of treatment options and confidence in their own skills.
6-9 These negative attitudes have been shown to adversely affect physicians’ abilities to detect and treat patients with alcohol and drug addiction.
8,10,11 One study from 2018 that assessed medical students’ opioid-specific knowledge and attitudes found that medical students and physicians lacked knowledge regarding patients at highest risk for opioid overdose as well as best treatment practices for opioid use disorder.
12 Additionally, medical students held more negative attitudes than physicians regarding the efficacy of recovery treatments.
12 Therefore, negative attitudes toward opioid addiction might act as barriers to the care of patients struggling with opioid dependence.
To address the concerns of inadequate opioid-related care and excessive prescribing practices, educators have called for pain- and opioid-specific courses in health professional school curricula with a focus on the psychosocial components of pain.
13-16 Experiential learning may be one way for health professional schools to accomplish this task.
17 A study of medical students in Connecticut demonstrated that a lecture-based intervention accompanied by clinical training was effective in improving students’ attitudes toward general addiction and confidence in their treatment abilities.
9 Although the study included some opioid-specific questions, its aim was to investigate addiction attitudes in general.
9 To our knowledge, there has been limited research on opioid-specific attitudes and beliefs of health professional students. Additionally, research has not described the opioid-related experiences that students are already exposed to as part of their academic programs and daily lives. Understanding how these experiences influence postgraduate plans could inform the development of future curricular interventions.
To build on the limited body of research, this study was conducted to address future prescribers’ beliefs, experiences, and postgraduate plans related to opioids. In addition, the study explored the relationship between personal and clinical experiences with opioids and postgraduate plans. We hypothesized that opioid-related experiences would be positively associated with postgraduate plans to engage in opioid-related work after graduation.