Students at Harvard Medical School may just be the first doctors-in-training to learn how to administer one of the most effective drugs for combating America's opioid epidemic. But they had to organize the class themselves.
The students were frustrated by the dearth of formal coursework on treating addiction -- at Harvard and other medical schools -- even as overdoses from heroin, fentanyl and pain relievers like oxycodone are reaching record numbers. In 2014, at least 28,647 people died of opioid overdoses in the U.S.
So this semester, some of the future doctors at Harvard's Center for Primary Care arranged for optional trainings on administering buprenorphine, which eases a person's cravings for opioids, as well as naloxone, which can save the life of someone who has overdosed on an opioid.
"What kind of a doctor would I be if I didn't know how to do this?" said John Weems, a fourth-year medical student, who helped initiate the training sessions.
The use of buprenorphine, a prescription drug also known by the brand name Suboxone, is tightly controlled. Only doctors who receive a Drug Enforcement Administration waiver after completing an eight-hour course can prescribe it, and there are caps on how many patients a doctor can see. Yet when combined with counseling in what's known as medication-assisted treatment, it's an effective way to treat opioid addiction.
Unfortunately, fewer doctors than needed have signed up to prescribe buprenorphine, so the Obama administration in March proposed increasing the number of patients permitted per doctor.
This semester, 19 Harvard students took the exact course required by the DEA as a pilot program. They were likely the first to receive that training before obtaining their medical degree, according to Dr. Joji Suzuki, a Harvard psychiatrist who conducted the course.
Suzuki said the current generation of med students shows much more interest in learning about addiction than did their predecessors who are now setting the curriculum.
"It's no secret that addiction in the American medical training system has not been comprehensive," he said. "The ironic part is that the opioid epidemic has been raging for over a decade, but there are effective treatments that are already available."
It's unclear whether the students' training can later be credited toward the DEA requirements, because usually only resident physicians or full-fledged doctors take the course. But Weems, who received the buprenorphine training, said he's part of a team that will publish a study on the pilot program.
"That publication will offer some data that will hopefully open up a conversation among the medical community about the future of training med students in buprenorphine administration," Weems said.
Buprenorphine can help patients over the longer term. Naloxone can save the life of someone overdosing an opioid right now. It's relatively easy to administer, and it's even available without a prescription in Massachusetts.
Yet few med students learn how to use the drug, which is sold under the brand name Narcan in the form of a nasal spray.
This semester, about 200 Harvard students learned how to use Narcan after a required lesson in basic life support procedures. Some students, who led this training, later taught nurses and other medical professionals in clinics around Boston how to use naloxone, too.
Student Siva Sundaram said he hoped the training would also reduce the reluctance among doctors to work with people with substance abuse disorders.
"We’re really trying to figure out how to reach people early on in medical school before they acquire the basic assumptions that addiction is impossible to treat," he said.
For decades, substance abuse in America was treated less as a public health concern and more as a matter for the criminal justice system. But those attitudes are changing.
Any high school can obtain an overdose reversal kit through a partnership of the Clinton Foundation and Adapt Pharma, Narcan's manufacturer. On May 14, rapper Macklemore spoke about his struggle with opioids on President Barack Obama's radio address. Congress is currently considering a range of bills aimed at the opioid epidemic, some of which focus on opioid treatment and recovery.
The concerns and attitudes of current medical students could usher a shift in medical training as well.
"The diseases which were so very common, life-threatening, and shortening of yesterday were those that shaped the medical school curriculum experiences," said Dr. Mark Gold, an addiction specialist retired from the University of Florida. "These students know what problems they see in their peers, their classmates, and on their rotations throughout the medical school."