New Jersey’s oldest medical school has become the first in the nation to ensure its graduates will be equipped with the federal certification needed to provide medication-assisted treatment, now considered the gold standard for addressing opioid addiction.
Rutgers New Jersey Medical School, in Newark, announced last month that it had updated its curriculum to better prepare physicians to practice safe, effective pain management and also prescribe drugs like buprenorphine to help those with substance-use disorders manage their disease. The first class to be fully trained includes 185 students slated to graduate next spring.
Going to the MAT
The federal government regulates the training and certification for buprenorphine, naloxone, and other medication-assisted treatments, or MATs, which involves prescribing low dosages of narcotics to control cravings and reduce addictive behavior, enabling drug users to lead a more productive and satisfying life.
But this process has not been incorporated into medical school curricula and, despite a growing number of physicians becoming certified after graduation, there remains a shortage of MAT prescribers in New Jersey and nationwide, experts agree.
Training providers in school makes sense, given the scope of the opioid epidemic, explained Dr. Petros Levounis, a professor who chairs the psychiatry department at NJMS and serves as chief of service at University Hospital in Newark.
“We need to start with a new generation. We need to start with the medical students,” he said, to help build a more effective treatment system from the bottom up. “We need all the help we can get in 2018.”
Heroin, pills like oxycodone and other opioids kill approximately, 142 Americans daily, a press release from Rutgers NJMS noted, and at least eight in 10 addicts never get proper treatment. In New Jersey, tens of thousands of residents seek treatment for addiction annually and more than 2,200 died of drug overdoses in 2016 — including nearly 1,350 who had heroin in their blood, a 40 percent increase over the previous year — according to a new website created by the state attorney general’s office.
New Jersey has increased controls over prescription opioids, legal medications that are highly addictive and can lead to illicit and illegal drug use. Last year the state adopted the nation’s strictest limits on first-time opiate prescriptions, and it has continued to expand efforts to reduce “doctor shopping” by strengthening the state’s prescription-monitoring program.
But experts agree there is also a need for additional treatment options. The use of medications like buprenorphine, an oral or sublingual drug that can be administered by primary-care providers and a wide range of other physicians in outpatient settings, has been credited with helping individuals diagnosed with substance-use disorders to re-integrate with daily life and succeed in their recovery. Other formulations, including versions of naloxone, can be administered by injection every three months. MATs guard against withdrawal but don’t involve the same highs and addictive behavior as heroin and other opioids.
Former Gov. Chris Christie was a vocal advocate for the treatment protocol when he led the White House task force to address opioid addiction last year. On his way out of office last month, Christie signed a law requiring treatment providers in New Jersey to offer MAT to appropriate patients — further increasing the demand for credentialed prescribers.
Rutger’s Levounis stressed that a lot of medical schools have excellent opioid-treatment curricula in place — a theme echoed by a recent presentation created by the Association of American Medical Colleges. and Brown University’s medical school, in Providence, RI, also trains its students in MAT procedures. But the Brown program does not include the final federal certification process, he said, instead offering graduates a letter from the Rhode Island governor attesting to their skills.
The eight-hour training and certification process for MAT is overseen by the federal Substance Abuse and Mental Health Services Administration, thanks to a 2000 law that allowed select physicians to administer the medicines to a limited number of patients; the cap on the number of patients has been increased several times since. (Methadone, a similar replacement therapy under use for decades, is governed by a separate process and can be distributed in larger clinic settings.)
A growing number of experts — and students — believe this training protocol, which qualified physicians can take online or in person, should also be a standard part of American medical education. Levounis said it makes no sense to deny graduates access to MAT when they leave school qualified to administer all other available drugs, including highly toxic chemotherapy cocktails that the vast majority of physicians will never need to prescribe.
The program at NJMS — one of five credentialed medical schools in New Jersey and one of two associated with Rutgers University, along with the Robert Wood Johnson Medical School in New Brunswick — will involve a mix of live, classroom discussion, and online tutorial, according to Levounis.
The curriculum was developed through a group led by Levounis, Dr. Sangeeta Lamba, associate dean of education, and Dr. Lewis Nelson, chair of the emergency medicine department.
The program also involves a new textbook focused on buprenorphine treatment, written by Levounis and two colleagues from Boston University Medical School, which includes sections on new formulations and federal laws, information about adjusting doses in long-term patients, advice on treating pregnant women with opioid-use disorders, and suggestions for dealing with traditional 12-step groups, like Alcoholics Anonymous, that have resisted the notion of using a narcotic medication to assist with recovery.