Equal Treatment: Restoring and Expanding Medical and Social Care for Substance Use Disorders

PRIMARY CARE CONSIDERED: The SLC Blog

Welcome to Primary Care Considered, the blog of the Student Leadership Committee at the Center for Primary Care. Featured monthly in the Center’s newsletter, this section will highlight the projects, activities, and past successes of the SLC. Please join us at our events and share your thoughts!

In this post, former SLC member Helen Jack shares her experiences as an advocate for the restoration and expansion of substance use disorder treatment facilities in Massachusetts. Following the closure of the Long Island Bridge, students from Massachusetts medical schools came together to found the organization Medical Students for Long Island, which has worked to expand access to substance use treatment and to improve medical student education around substance use disorders.  

A long-standing interest in substance use and mental health drove me to attend medical school. Here I have found a community of like-minded peers who are eager to stand together to improve substance use disorder education and care.

Twenty-three million Americans suffer from a substance use disorder (SUD). To put that into perspective, 29 million Americans suffer from diabetes. Both are chronic, potentially fatal diseases that need regular medical monitoring and management, and both can often be prevented through appropriate interventions.

While diabetes management plays a prominent role in every medical school’s curriculum, few schools adequately train students to care for patients with SUDs. Regardless of which specialty my classmates and I enter, we will surely see patients who have SUDs and must be able to provide them with a high standard of care.

A community of peers and I have begun advocating around SUD education and treatment. Our work began last year, in response to the closure of the closure of the Long Island Bridge in October 2014. Long Island provided much needed social services such as emergency shelter, detoxification, and SUD treatment facilities to up to 1,000 individuals in Boston, and these facilities were abruptly closed when the bridge to the island was declared structurally unsound.

In response to the inadequate municipal response to this crisis, students from Harvard, Tufts, and Boston University came together to found Medical Students for Long Island and were soon joined by medical students from University of Massachusetts.

Many HMS students in Medical Students for Long Island are current or former members of the Student Leadership Committee (SLC) at the HMS Center for Primary Care, and the SLC has taken an active role in many of our actions.

The group started by advocating for the restoration of the SUD treatment facilities that were shut down when the bridge to Long Island was closed. Together, we wrote op-eds, spoke at public hearings, protested, and organized a sign-on letter to Mayor Walsh, often working closely with the Boston Homeless Solidarity Committee.

Through our advocacy around the closure of the Long Island Bridge, the other members of Medical Students for Long Island and I saw that the loss of the beds on Long Island was only part of the problem with SUD treatment in our communities. Even before the bridge closure, there were not enough short- or long-term treatment beds and too few physicians who were licensed to prescribe buprenorphine.

Medication assisted therapies, such as buprenorphine (Suboxone), are among the most evidence-based treatments for opioid use disorder. In a study of MassHealth (Massachusetts Medicaid) patients on buprenorphine or methadone had a 50% lower relapse rate than those receiving behavioral therapy alone. Physicians, however, must have a waiver from the Substance Abuse and Mental Health Services Administration (SAMHSA) and support from their practice in order to prescribe buprenorphine.

Moreover, because few of our clinical preceptors have this license, we as students get little hands-on training in these often life-saving therapies. Having more clinical faculty who prescribe buprenorphine would not only improve our medical education, but also allow more people in Boston to have access to this important medication.

Our advocacy work today is more important than ever. Massachusetts is in the midst of an opioid epidemic. In response to the persistently rising number of overdose deaths and the concerns of many constituents, Governor Charlie Baker has developed an opioid action plan that addresses addiction prevention, treatment, and stigma. As part of the action plan, Governor Baker drew together a group of physicians and medical educators to develop core competencies for medical students in substance use care.

In November 2015, Deans of all four of the medical schools in Massachusetts committed to the competencies, which cover three “prevention domains:” appropriate prescription of opioids, treating patients at risk for opioid misuse, and managing substance use.

I’m thrilled to see the competencies and am eager to help support their implementation here at Harvard and within the rest of the state’s medical schools. These competencies promise to bring us closer to a model of medical education that treats addiction as the highly prevalent, chronic disease that it is.

While the competencies mention medication-assisted treatment, treatment in general—and medication-assisted treatment in particular—receive far less emphasis than prevention. Treatment, in addition to prevention, must be central in any set of competencies proposed for medical students. I need training on how to appropriately prescribe pain medications to prevent unhealthy opioid use, but I also want to make sure that my classmates and I know how to treat patients who are already addicted—those who are suffering today.

While Governor Baker was still in the process of developing his core competencies, Medical Students for Long Island wrote an open letter to the deans of our medical schools, urging them to emphasize treatment, alongside prevention, in the development of the core competencies, and work to implement more comprehensive education on SUD treatment at their schools. After more than 300 health professional students and colleagues signed the letter, we sent it to our deans; Governor Charlie Baker; Monica Bharel, MD, MPH, the Commissioner of Public Health; and Marylou Sudders, Secretary of the Executive Office of Health and Human Services.

In response to our letter and following the release of the competencies, Governor Baker invited us to meet with him to discuss substance use education for medical students and his proposed legislation. We emphasized the importance of medication-assisted treatments, both as part of medical education competencies and a broader state strategy for combatting the opioid epidemic. Following our meeting, Governor Baker and members of our group were invited to speak with the press, continuing to emphasize our focus on the importance of these therapies.

We are eager to continue working with Governor Baker and Commissioner Bharel on SUD education and to bring the proposed competencies, as well as even more training on medication-assisted treatment and harm reduction strategies to our future curricula. We want to make sure that the need for comprehensive treatment options are part of all state and local conversations about the opioid epidemic and that Massachusetts continues to expand the number of treatment beds available. We also plan to be part of the statewide discussion about legislation on the opioid epidemic that the Governor has proposed and that the House is likely to put forward in 2016.

Medical Students for Long Island and our supporters will continue to push for readily available, dignified treatment for all. As medical students, we have a responsibility to take action. We want to be a generation of physicians that will treat addiction equitably, and without stigma—as the chronic disease that it is.

If you are interested in being a part of Medical Students for Long Island or learning more about our work, please email Helen_Jack@hms.harvard.edu.