Using contact-based education to destigmatize opioid use disorder among medical students

Abstract

Problem: Opioid-related overdose deaths are a significant public health concern globally, and current recommendations to address chronic pain and opioid-related stigma in medical curricula may be accomplished using contact-based education. To assess the effectiveness of this technique in changing medical students’ opioid use disorder (OUD) stigma and opioid-related postgraduate intentions, the authors implemented two curricular interventions – (1) a modified contact-based education panel and (2) a didactic lecture – at a medical school. Intervention: Medical students were randomized to a curricular intervention and completed pre- and post-assessments to measure opioid misuse knowledge, opioid-related postgraduate intentions, and OUD stigma. One group of participants attended a lecture on opioids and medication assisted treatment (MAT) developed by a clinical psychiatrist; a second group interacted with a 5-member panel of opioid content experts and an individual in recovery. We conducted Fisher’s exact tests, paired t-tests, repeated-measures mixed ANOVAs, and logistic regression to examine changes in pre- and post-assessment responses.

Context

All first- and second-year (i.e., pre-clinical) medical students at a large, Midwestern medical school with three campuses were invited to participate in a two-arm, parallel educational study comparing the efficacy of two types of curricular interventions. Students at the main campus attended the modified contact-based education panel or the didactic lecture in person, while students at the two distance campuses attended the modified contact-based education or lecture remotely using the University’s videoconferencing system. Impact: A total of 109 students participated in the study (average age 24.2 years (SD = 2.6), 64.2% female, 79.8% white, 56.0% second-year students, 67.9% attended on main campus, lecture = 52 participants, modified contact-based = 57 participants). Baseline responses were similar across groups. Following the session, participants in both interventions rated drug abuse (percent increase = 21.2%, p < .001) and prescription drug diversion (percent increase = 7.6%, p = .004) as more serious problems. Participants from both interventions expressed increased confidence in caring for patients with OUD (percent increase = 45.5%, p < .001) and increased interest in pursuing MAT training (percent increase = 21.5%, p = .04). Both curricular interventions were equally effective at reducing OUD stigma with a significant 8.2% decrease in total stigma scores and a large effect size (p < .001, η_p² = .34). Lastly, participants with lower post-assessment OUD stigma scores were more likely to indicate that they would pursue additional training to provide MAT (p = .02). Lessons learned: Exposure to opioid-specific education with a focus on MAT and recovery, regardless of education type, positively affected opioid-related postgraduate intentions and reduced OUD stigma. Notably, these findings suggest that there are multiple efficacious techniques to reduce OUD stigma during preclinical training.

Keywords:

• Opioids
• opioid use disorder
• medical education
• osteopathic medicine

Acknowledgements

The authors wish to thank the creators of the OMS-HC scale for allowing us to revise it and use it as a measurement instrument for our research. The authors also thank the students who participated in the study, volunteering their valuable time amid all their medical school classes and exams. Additionally, the authors thank the members the University and southeastern Ohio communities who participated on the opioid panel and donated their time to share their experiences working with patients with OUD.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This study was funded by the Ohio University Student Enhancement Award, and SCM is supported by a fellowship from the Osteopathic Heritage Foundations, dual degree program at Ohio University Heritage College of Osteopathic Medicine.