Alyssa Cole,Tyler Igoe, and Morgan Avery
TREATING OPIOID ADDICTION
CU students design curriculum to address substance use disorders
By Greg Glasgow
April 2023
Three University of Colorado School of Medicine students are developing a curriculum to provide better care for treating opioid addictions and overdoses.
Doctoral students Tyler Igoe and Alyssa Cole, along with Morgan Avery, a student in the Physician Assistant Program, are receiving support from the Coalition on Physician Education in Substance Use Disorders, also known as COPE, to help put their plans in motion. COPE aims to integrate addiction medicine content into core clerkship rotations and other clinical experiences.
Igoe, Cole, and Avery were one of four teams from schools of medicine nationwide selected in COPE’s 2022 Curriculum Innovation Challenge: Innovative Learning and Teaching About Substance Use/Opioid Use Disorders.
The CU students will develop their curriculum under the supervision of D. Tyler Coyle, MD, MS, assistant professor of psychiatry. They also will meet with COPE staffers and the other student teams. The launch date for the new curriculum is fall 2023.
The CU team will develop and implement a new curriculum that teaches medical students how to administer naloxone, an opioid overdose reversal drug, and how to use microdose induction of medication buprenorphine to ease withdrawal symptoms in people with opioid use disorder.
“Part of the challenge with addiction medicine is that it’s a very evolving field,” Cole says. “People are starting to pay more attention to it and try new things and look for new treatments.”
UNDERSTANDING NALOXONE
Designed for fourth-year medical students during the Transition to Residency phase of their training, the new curriculum will train students on the use of naloxone to care for a person experience an overdose.
Students will be trained to identify symptoms of an opioid overdose, describe the mechanism of action of naloxone, administer naloxone to patients, and understand the public health importance of prescribing and dispensing naloxone to people at risk of overdose.
“Naloxone is an example of the ways in which harm reduction and public health are blending with medicine,” Avery says. “It’s something that a lot of clinics give out for free. There are ‘standing orders,’ or third-party orders, where you can prescribe it to someone knowing that they’re not the person that will use the medication, because it’s so readily available. And it’s a great tool. We want to arm people with that knowledge.”
MICRODOSING BUPRENORPHINE
While naloxone is used in acute overdose situations, buprenorphine is a long-term treatment for opioid addiction that reduces drug craving and withdrawal symptoms. The second part of the CU students’ COPE curriculum will train students on novel strategies to use buprenorphine in patients seeking treatment for opioid use disorder.
“Buprenorphine is similar to methadone, but it tends to be preferred by a lot of people with opioid use disorders,” Cole says. “There are a lot of barriers with methadone: you have to go to a clinic every day; it makes some patients drowsy. A lot of people prefer buprenorphine, but it can precipitate withdrawal symptoms.”
By administering microdoses of buprenorphine that slowly replace opioids in the system, providers can help patients avoid withdrawal symptoms, making them more likely to engage in treatment. The COPE curriculum will teach students how buprenorphine works, why microdosing is effective, and how to identify eligible patients for buprenorphine microdosing.
“It will set students up to be more successful and more comfortable in treating patients with opioid use disorder, both in an acute setting with overdose, and managing the transition if someone wants to overcome their addiction,” Igoe says. “It will also put our students at the forefront because this is such a new thing. A lot of providers aren’t familiar with the microdosing technique for buprenorphine yet. We will be able to contribute to a team right away by teaching everyone something new.”