As 2018 wraps up, so does the first year of PAEA’s partnership in a Substance Abuse and Mental Health Services Administration (SAMHSA) grant to help tackle the opioid crisis that each year continues to take more than 40,000 lives and cost more than $500 billion. The grant funds a project to encourage PA programs to train students and faculty in medication-assisted treatment (MAT) for opioid use disorder (OUD) and make them eligible for the DEA waiver they need to be able to prescribe buprenorphine for opioid addiction. Earning the waiver requires completion of 24 hours of training, available online through PAEA’s grant partner the American Academy of Addiction Psychiatry, as well as a number of other organizations listed on PAEA’s MAT Waiver Training Initiative webpage. PAEA’s goal is to have all PA students graduate with eligibility for the waiver, according to project leader John Lopes, DHSc, PA-C, a faculty member at the Central Michigan University PA Program with many years of clinical experience in OUD treatment. (Watch Dr. Lopes’s video here.) Another aspect of the project that should pay long-term dividends is an initiative to encourage all programs to have students apply for NPI numbers, which will make it easier to track graduates practice patterns and potentially generate data for federal funding purposes.
We spoke to a handful of PA programs that have begun incorporating the MAT training into their curricula and offer some lessons learned from these trailblazers.
Why are PA programs taking on this topic?
“The opioid epidemic is growing; it is getting bigger everywhere,” said Gerald Kayingo, PhD, PA-C, director of the UC Davis program in Sacramento, among the hardest-hit areas of California, he said. “Our students and most providers have not been given the skillset to manage these issues.” Kayingo’s program surveyed both its students and local providers and found that “most respondents reported that they did not have the skills and were not comfortable dealing with [OUD] patients.”
For two Massachusetts programs, the impetus was a push by the governor, Charlie Baker, who established a working group through the state’s public health commission to tackle OUD in the state, including funding for MAT and development of learning objectives and curriculum around safe prescribing of opioids. “It was a three-pronged public health approach,” said Susan White, MD, director of didactic curriculum at the Boston University (BU) PA Program. “The state developed educational competencies for medical school graduates, then dentists, then finally PAs.” BU students have been doing the MAT curriculum for the past two years now.
Across town at Northeastern University, the PA program also began to incorporate OUD and MAT into their curricula. Associate Program Director Dipu Patel, MPAS, PA-C, who is also chair of the state PA licensing board (and a director at large on the PAEA Board of Directors), remembers a meeting at the 2016 Education Forum at which all of the Massachusetts programs presented ideas on how their programs could incorporate more OUD content into their curricula. “There was a lot of urgency around this issue,” said Patel. “We helped create this problem as providers and we need to be part of the solution.”
How are programs incorporating MAT into their curricula?
All of the educators we spoke to agreed that the best time to incorporate the MAT training is in the clinical year, when students have enough experience seeing patients to understand the context better.
The BU program has students come back to campus for one whole day, to do the first 8 hours of the MAT training (for which they earn a certificate) in one chunk, then leaves them to do the remaining 16 hours on their own before they graduate.
All the educators we spoke to stress that while the MAT curriculum covers a lot of important material, it may not be enough on its own. “Students need a comprehensive addiction curriculum,” said Rachel Byrne, MS, PA-C, a faculty member at the University of Colorado PA Program, who coordinates the behavioral health portion of the program. “They need a base to work from. The MAT training doesn’t really cover how to talk to patients, and the causes of the epidemic.” Byrne has all of her students read Dreamland, a book that investigates the roots of the opioid epidemic and how it has devastated hundreds of small towns across America. Her program has adopted a similar approach to BU’s, but they encourage their students to take the remaining 16 hours after they have completed the PANCE exam, when they can earn CME for their efforts.
Teaching students about OUD and MAT brings together several strands of curriculum, educators said. “This is not just about physical illness,” Patel noted. “It touches on mental health and socioeconomic factors; it’s a good way to get students more aware of the social determinants of health.”
“It requires a multidisciplinary approach,” agreed Kayingo, who also serves on the PAEA Board of Directors as director at large. “There’s the role of the pharmacist, who will dispense the meds. You need community resources, behavioral counselors. It’s not a simple scenario. These patients are very complex.”
Finding the time in the curriculum can be a bit of a challenge, of course, but students and faculty appear to be embracing the challenge so far. “We expected a certain amount of grumpiness from students but did not see it,” said White. “The course evaluations were good. Students have seen patients by the time they do it so have a sense of why it is important.” And faculty are on board too. “As I educate the students on the MAT training, the clinical team is supportive of the students doing the initial hours during their clinical year and there is little additional workload for the faculty. It’s easy to add this into the program,” said Byrne.
At UC Davis, Kayingo and his colleagues have collected some data on the effectiveness of their OUD curriculum, including the MAT training, and found a statistically significant difference in students levels of confidence in speaking to patients with addiction problems after completing the training. UC Davis puts its students through a four-hour session of clinical scenarios, conducted with their NP and physician resident colleagues in an interprofessional setting – “it mirrors how they practice,” said Kayingo.
The program also surveyed its graduates to ask whether they planned to apply for the X waiver once certified and more than 80 percent said yes. “Students are putting it on their CVs. It is a skill that employers are looking for,” said Kayingo. “It is definitely a resume builder for students,” Patel added.
For more information on PAEA’s MAT Initiative, please contact John Lopes at firstname.lastname@example.org and visit our webpage.
Funding for this initiative was made possible by grant no. 1H79TI080816-01 from SAMHSA. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.