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Arizona Pain and Addiction Curriculum Faculty Guide

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Arizona Pain and Addiction Curriculum Faculty Guide THE ARIZONA PAIN AND ADDICTION CURRICULUM FACULTY GUIDE 1 THE ARIZONA PAIN AND ADDICTION CURRICULUM FACULTY GUIDE | azhealth.gov/curriculum 2 THE ARIZONA PAIN AND ADDICTION CURRICULUM FACULTY GUIDE | azhealth.gov/curriculum September 1, 2018 Dear Teaching Faculty: It is our pleasure to offer this Faculty Guide as a supplement to The Arizona Pain and Addiction Curriculum. Whether your program is educating future physicians, nurses, physician-assistants, dentists, naturopathic doctors or podiatrists – this Faculty Guide can be used to enhance the statewide vision of redefining pain and addiction. The essence of the curriculum rests with its ten Core Components – this Faculty Guide provides a further level of detail under each Component and Objective. As colleagues in health care, we understand that this material represents a significant change from the way we were taught about pain and addiction – or the way we were taught about medicine at all. This curriculum moves from a micro- to a macro- perspective, stressing whole-person care and the societal impact of pain and addiction. It reflects the interrelated nature of pain and addiction – two areas that have been traditionally siloed. It specifically calls for clinicians to be able to critically analyze material, their own practices, and their own biases. The approach to pain and addiction is advancing rapidly. The material in this Faculty Guide is aggressively up-to-date and evidence-based, yet remains in line with the National Pain Strategy, the Institute of Medicine and modern educational theories. As our understanding of pain and addiction changes, so too will this document. We are proud to have worked with programs’ leadership to develop this curriculum and are now excited to work with you to bring it to Arizona learners. Sincerely, Lisa Villarroel, MD MPH Aram Mardian MD Co-chair of the Arizona Statewide Curriculum Workgroup Co-chair of the Arizona Statewide Curriculum Workgroup Medical Director, Public Health Preparedness Chief, Chronic Pain Wellness Center Arizona Department of Health Services Phoenix VA Health Care System THE ARIZONA PAIN AND ADDICTION CURRICULUM FACULTY GUIDE | azhealth.gov/curriculum 3 4 THE ARIZONA PAIN AND ADDICTION CURRICULUM FACULTY GUIDE | azhealth.gov/curriculum INTRODUCTION PURPOSE The Arizona Curriculum on Pain and Addiction represents a large-scale culture shift in the education of the next generation of clinicians. While the curriculum aims to bring about focused results such as a reduction in the number of opioid-related overdoses, a reduction in opioids unnecessarily prescribed, and an increase in the number of providers able to treat opioid use disorder – this curriculum moves beyond these discrete goals to redefine pain and addiction as interlinked, complex, public health processes, requiring interprofessional care and involvement of the community and health-based systems. BACKGROUND On June 5, 2017, Governor Doug Ducey declared a Statewide Public Health Emergency in Arizona due to the Opioid Epidemic. One of the recommendations from the Arizona Department of Health Services was to create a statewide curriculum on pain and addiction for all clinicians who prescribe opioids. Beginning in January of 2018, four meetings were held with Deans and Curriculum Representatives from all eighteen MD, DO, PA, NP, DPM, and ND programs in Arizona. A final, modern curriculum was completed in June of 2018, and was based upon the following concepts: • The link between pain and addiction • The use of a macro- to micro- perspective to pain and addiction (the socio-psycho-biological approach) • The destigmatization of pain and addiction • The evidence base of pain and addiction care • The influence of the pharmaceutical industry on clinicians • The need for clinician and system introspection, both in personal biases and excellence of care Since its publication, the curriculum has garnered national attention and has been requested by a number of states and program types. FACULTY DEVELOPMENT In response to increasing local and national requests for faculty development in regards to pain and addiction, this Faculty Guide provides further levels of detail into each Component and Objective. A Curriculum Summit was held in November of 2018 for all Arizona teaching faculty to introduce methods of conveying this material, including interactive sessions and exploration of the newer concepts presented in the curriculum. Details of this summit are available at www.azhealth.gov/curriculum. Each summer of 2019, 2020, and 2021, leadership from the Arizona programs will be gathering at the Arizona Department of Health Services to discuss implementation of the curriculum and challenges faced. Specific guidance, concerns or requested adjustments for further faculty support or curricular adjustment can be made at that time. THE ARIZONA PAIN AND ADDICTION CURRICULUM FACULTY GUIDE | azhealth.gov/curriculum 5 INTRODUCTION STRUCTURE AND INTENDED USE The structure of the original Arizona Pain and Addiction Curriculum and this companion Faculty Guide are organized by a set of ten Core Components, each of which is expanded and detailed into specific Objectives and Key Readings. There are a set of Appendices included at the back of this Faculty Guide, which include tools and resources, and also a detailed guide to the use of buprenorphine for opioid use disorder. The letter included specifically for medical schools and other health professional schools who intend to include this content in their standard curriculum. The Arizona Pain and Addiction Curriculum is pertinent to all program types, and the Core Components are able to be expanded and contracted in detail, accordion-style, as pertinent. This Faculty Guide provides a greater level of detail, but it is not exhaustive and certain programs may elect to surpass what is covered. While the Curriculum addresses different types of pain and addiction, there is a primary focus on non-cancer, non-terminal pain and opioid use disorder. Of note, this Faculty Guide, along with the original Arizona Pain and Addiction Curriculum, are public materials. They are non- proprietary and can be used outside of the state in any health educational program. Although permission is not required, email notification of programs’ use of the materials is appreciated (email: [email protected]). DISCLOSURES All contributors to this Faculty Guide have submitted and declared No Financial Relationships to Disclose. The Arizona Pain + Addiction Curriculum, the Faculty Guide and the 2018 Curriculum Summit have been funded entirely by state and federal public health agencies. Industry offers for sponsorship have been declined. NATIONAL REFERENCES • Institute of Medicine. (2011) Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: National Academies Press. https://doi.org/10.17226/13172 • Interagency Pain Research Coordinating Committee. (2016) National Pain Strategy: A Comprehensive Population Health-Level Strategy for Pain. https://iprcc.nih.gov/sites/default/files/HHSNational_Pain_Strategy_508C.pdf • U.S. Department of Health and Human Services; Office of the Surgeon General. (2016) Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. Washington D.C: HHS. Available from: https://www.surgeongeneral. gov/library/2016alcoholdrugshealth/index.html • U.S. Department of Health and Human Services; Office of the Surgeon General. (2018) Facing Addiction in America: The Surgeon General’s Spotlight on Opioids. Washington D.C: HHS. Available from: https://addiction.surgeongeneral.gov TABLE OF CONTENTS • Curriculum Vision • Core Components #1-10 • Faculty Guide for Core Components #1-10 • Appendix A: Arizona and National Resources • Appendix B: Clinical Tools for Pain and Addiction • Appendix C: Risk Factors for Adolescent and Young Adult Substance Use • Appendix D: Buprenorphine Treatment for Opioid Use Disorder • Glossary • References • Acknowledgments 6 THE ARIZONA PAIN AND ADDICTION CURRICULUM FACULTY GUIDE | azhealth.gov/curriculum VISION + CORE COMPONENTS CURRICULUM VISION To redefine pain and addiction as multidimensional, interrelated public health issues that require the transformation of care toward a whole-person, interprofessional approach with community and systems perspectives. CORE COMPONENTS Upon graduation from a health professional education program in Arizona, a student should demonstrate the independent ability to: UPDATES TO THE GUIDELINES REDEFINE PAIN + ADDICTION 1 Define pain and addiction as multidimensional, public health problems. Describe the environmental, healthcare systems and care model factors that have shaped the current opioid 2 epidemic and approach to pain care. Describe the interrelated nature of pain and opioid use disorder, including their neurobiology and the need for 3 coordinated management. APPLY AN EVIDENCE-BASED, WHOLE-PERSON APPROACH TO PAIN + ADDICTION 4 Use a socio-psycho-biological model to evaluate persons with pain and opioid use disorder. Use a socio-psycho-biological model to develop a whole-person care plan and prevention strategies for persons 5 with pain and/or opioid use disorder. Reverse the unintended consequences created by the medicalization of chronic pain by empowering persons 6 with self-management strategies, and include an awareness of chemical coping. Use and model language that destigmatizes, reflects a whole-person perspective, builds a therapeutic alliance 7 and promotes behavior change. INTEGRATE CARE
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