Lily Rabinow, MS, a medical doctorate candidate at the University of Massachusetts Medical School (UMMS), recognized the need for physicians, in particular pediatricians, to be better trained in treating opioid use disorders with the use of medications.
Her solution was to make her Capstone project focused on medication assisted treatment (MAT). This year, all pediatric residents at UMMS will be asked to complete the PCSS-MAT 8-hour training as part of their month-long adolescent medicine training. Ms. Rabinow is using MAT waiver training as her Capstone project for a variety of reasons, including the work she’d done at the Boston Children’s Hospital Adolescent Substance Abuse Program (ASAP) before starting medical school.
“I was moved by the impact that this medication has had on adolescents in treatment of opioid use disorders (OUD) through my experience and training while working at Boston Children’s Hospital with Dr. Sharon Levy, an addiction specialist and pediatrician at ASAP,” Rabinow said. Dr. Levy is the director of ASAP and a national leader in in policy, training and research in adolescent substance use disorders. During her time at ASAP, Ms. Rabinow was exposed to information about the shortage of pediatric providers who have completed MAT waiver training and the need for more skill development. “I thought that incorporating MAT training into a pediatric residency program could be a feasible approach to systematically expand the workforce of pediatricians who are equipped to offer this treatment.”
Too few pediatricians have completed the training to prescribe buprenorphine for the treatment of OUD, she said, creating a large gap in treatment for teens and young adults aged 14 to 24. Physicians who treat adults are often reluctant to treat adolescents, she noted. Buprenorphine is one of three FDA-approved medications for the treatment of OUD.
The hope, she said, is that UMASS will make the eight-hour course mandatory for all pediatric medical residents. The need is significant, she said—in Massachusetts 114 individuals between the ages of 15 and 24 died of overdose in 2016, accounting for just under a quarter of all deaths in that age group.1 “The state medical school, in a state that has been so deeply impacted, is a fitting place to start this pilot,” she said.
The American Academy of Pediatrics, in conjunction with PCSS-MAT, developed the 8-hour MAT waiver course designed specifically for pediatricians. Integrating the course into residency programs would go a long way toward filling the gap in preventing and treating OUD in adolescents, Rabinow said.
While the training is not mandatory, all residents will be asked to complete the training as part of their month-long adolescent medicine training. The training residents will take a four-hour online training, then complete the eight hours with a live training later this year. Residents cannot receive their waiver until they complete their medical residency, and then they can apply to SAMHSA for their waiver to prescribe.
According to a Massachusetts Health Policy Commission’s Opioid Use Disorder Report from 2016, the state has just 105 long-term residential treatment beds for adolescents compared to 2,281 for adults2. At the same time, nearly 10 %t of opioid-related deaths3 and 13 percent of opioid-related emergency room visits4 are under the age of 24, according to the May 2017 Opioid1 -Related Overdose Deaths, All Intents, MA Residents – Demographic Data Highlights.
Ms. Rabinow credited several for their assistance int his effort. “Dr. Margaret Chang has been so supportive from the beginning, and Drs. Christina Hermos and Mark Vining have been extremely helpful in working with me to get this training incorporated into the curriculum at UMass,” Rabinow said. Dr. Hermos is assistant program director of the pediatric residency program and Dr. Vining is program director of the pediatric residency program. Dr. Chang, an instructor in the Department of Family Medicine at UMMS, is Rabinow’s advisor on the project.
If you are interested in learning more about how to integrate the 8-hour MAT waiver training into a medical school curriculum or to sponsor a training, contact: [email protected]
1. http://www.mass.gov/eohhs/docs/dph/stop-addiction/current-statistics/opioid-demographic-february-2017.pdf
2. http://www.mass.gov/anf/budget-taxes-and-procurement/oversight-agencies/health-policy-commission/publications/opioid-use-disorder-report.pdf
3. http://www.mass.gov/eohhs/docs/dph/stop-addiction/current-statistics/opioid-demographic-may-2017.pdf
4. http://www.mass.gov/eohhs/docs/dph/stop-addiction/current-statistics/emergency-medical-services-data-may-2017.pdf
