More than 60 medical schools across the United States were recognized by the White House this week for pledging to teach medical students about the dangers of prescribing opioids to patients for pain. The pledge confirms participating medical schools will include new guidelines from the U.S. Centers for Disease Control (CDC) on the use of prescription opioids – and comes in conjunction with President Obama’s announcement of additional public-private efforts to fight the nation’s epidemic of prescription opioid and heroin abuse that kills tens of thousands of Americans every year.

The prescriptive use of opioids has direct ties to the nation’s growing heroin epidemic – the CDC reports three of four people using heroin began with prescription opioids, making such prescriptions gateway drugs to the highly addictive street narcotic.

The University of Central Florida (UCF) joins medical schools like Tulane, Tennessee, Ohio State and Baylor (see complete list below) that will require medical students to get increased training in prescribing such pain medications before they graduate. UCF will begin the expanded curriculum in the fall.

“All you have to do is pick up the newspaper or watch TV and you see the cases of addiction, deaths and crime we are facing because of the misuse of pain medication,” said Dr. Richard Peppler, UCF’s associate dean for faculty and academic affairs, who helped lead UCF’s pledge. “We want to be leaders in medicine and this is a public health issue we need to help address.”

The school’s curriculum already addresses the dangers of prescribing opioids, but a year ago, Dr. Martin Klapheke, assistant dean for medical education and a psychiatrist by training, asked for a complete accounting of where and how often the topic was addressed in light of the national epidemic of prescription drug deaths and overdoses. Now Klapheke is leading a UCF task force to recommend, design, and implement an expanded curriculum that will begin with the new school year.

Klapheke says UCF’s goal is to provide the next generation of physicians with more evidence-based recommendations on issues such as when opioids should be prescribed and for how long, how patients should be monitored, when and how physicians should taper a patient’s dosage and how patients with previous substance abuse problems should be treated for pain. For example, the new training he is developing advises that except in instances of cancer, end-of-life or palliative care, opioids should generally only be used for short-term treatment of acute pain. The CDC guidelines indicate that three days or less is often sufficient to manage such pain and that more than seven days is not often needed Clinicians should not prescribe extra opioids “just in case” pain continues longer than expected; rather, the patient needs to be re-evaluated if pain persists.

The new instruction will also advise students to beware of providing chronic prescription of opioids for chronic non-specific pain, such as low back pain, headaches and fibromyalgia and to ensure that opioids are given only if the patient shows significant improvement in both his or her level of pain and physical function. The curriculum will also include more information on non-opioid pharmacologic treatments for pain as well as non-pharmacologic treatments, such as physical therapy and cognitive behavioral therapy.

Klapheke says physicians historically have not received a great deal of training on managing pain with prescription drugs, noting that when he attended medical school he received more information on prescribing antibiotics than on prescribing pain killers.

The medical schools that have pledged to  require their students to take some form of prescriber education, in line with the newly released Centers for Disease Control and Prevention Guideline for Prescribing Opioids for Chronic Pain include:

  • A.T. Still University of Health Sciences, Kirksville College of Osteopathic Medicine
  • A.T. Still University of Health Sciences, School of Osteopathic Medicine in Arizona
  • Baylor College of Medicine
  • Boston University School of Medicine
  • Burrell College of Osteopathic Medicine at New Mexico State University
  • Chicago College of Osteopathic Medicine of Midwestern University
  • David Geffen School of Medicine at the University of California – Los Angeles
  • Dell Medical School at The University of Texas at Austin
  • East Carolina University Brody School of Medicine
  • Edward Via College of Osteopathic Medicine - Auburn Campus
  • Edward Via College of Osteopathic Medicine - Carolinas Campus
  • Edward Via College of Osteopathic Medicine - Virginia Campus
  • Georgia Campus – Philadelphia College of Osteopathic Medicine
  • Hébert School of Medicine Uniformed Services University of the Health Sciences
  • Icahn School of Medicine at Mount Sinai
  • Kansas City University of Medicine and Biosciences College of Osteopathic Medicine
  • Lincoln Memorial University DeBusk College of Osteopathic Medicine
  • Loyola University Chicago Stritch School of Medicine
  • Marian University College of Osteopathic Medicine
  • Marshall University Joan C. Edwards School of Medicine
  • Mercer University School of Medicine
  • NYU School of Medicine
  • Ohio State University College of Medicine
  • Ohio University Heritage College of Osteopathic Medicine
  • Oklahoma State University Center for Health Sciences College of Osteopathic Medicine
  • Oregon Health & Science University School of Medicine
  • Perelman School of Medicine at the University of Pennsylvania
  • Philadelphia College of Osteopathic Medicine
  • Rocky Vista University College of Osteopathic Medicine
  • Rowan University School of Osteopathic Medicine
  • Rutgers Robert Wood Johnson Medical School
  • Saint Louis University School of Medicine
  • State University of New York Upstate Medical University
  • The Commonwealth Medical College
  • The Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo
  • Touro College of Osteopathic Medicine - New York
  • Touro University College of Osteopathic Medicine  - California
  • Touro University College of Osteopathic Medicine – Nevada
  • Tufts University School of Medicine
  • Tulane University School of Medicine
  • University of Arizona College of Medicine – Tucson
  • University of California – Davis School of Medicine
  • University of Central Florida College of Medicine
  • University of Colorado School of Medicine
  • University of Kansas Medical Center
  • University of Louisville School of Medicine
  • University of New England College of Osteopathic Medicine
  • University of North Carolina School of Medicine
  • University of North Texas Health Science Center at Fort Worth, Texas College of Osteopathic Medicine
  • University of Oklahoma College of Medicine
  • University of Pikeville - Kentucky College of Osteopathic Medicine
  • University of Rochester School of Medicine and Dentistry
  • University of Tennessee College of Medicine
  • University of Texas Southwestern Medical Center
  • University of Wisconsin School of Medicine and Public Health
  • Virginia Commonwealth University School of Medicine
  • West Virginia School of Osteopathic Medicine
  • West Virginia University School of Medicine
  • Western University of Health Sciences College of Osteopathic Medicine of the Pacific
  • Western University of Health Sciences College of Osteopathic Medicine of the Pacific Northwest
  • William Carey University College of Osteopathic Medicine