Issue 57 - Aug. 9, 2016
Making the Rounds with Founding Dean Dr. Barbara Atkinson
Friends and Colleagues,    

A recent National Public Radio story by Natalie Jacewicz highlighted an issue the UNLV School of Medicine is determined to avoid: The need for medical schools to better educate students about opioid addiction. The story pointed out how little time medical schools have spent teaching addiction medicine - sometimes just a single lecture during a student's first two years in school.
Meanwhile prescription drug use has reached epidemic proportions with 80 percent of the world's opioids and 99 percent of the world's hydrocodone consumed in the United States. The number of prescriptions written for opioids has quadrupled since 2000 - along with the number of deaths due to drug overdose.
Such startling statistics helped drive the development of our curriculum year-by-year to ensure UNLV School of Medicine students are prepared to help patients manage pain. Students need to understand the intricate balance between using medicine to keep patients comfortable during severe pain episodes and the risk of long-term misuse and addiction.
Opioids, a class of drugs, are used to decrease the intensity of pain by blocking signals to the brain. As a prescription, this class includes codeine for mild pain and hydrocodone (Vicodin), oxycodone, (OxyContin, Percocet), and morphine, all of which are used to stop moderate to severe pain. Heroin is the street drug that falls into this class.
Pain is real. There are many times when opioids are needed to treat acute pain after surgery, dental work, fractures, etc., and to treat chronic pain due to a back injury, cancer, and other chronic disease states. Problems occur when these prescription drugs are not used as prescribed, when extra drugs are prescribed, and when pills are sold on the street.
When prescription drugs are used over long periods of time or incorrectly there can be serious side effects. These include addiction, which is physical dependency; tolerance, which is the need for increasing dosages to achieve the same effect; and increased sensitivity to pain.
Managing pain
My own personal experience with pain medication as a patient comes from when I had knee replacement surgery, one of the most painful of the musculoskeletal surgeries. I was wary about pain medication and tapered completely off the prescription as fast as I could. My surgeon helped me understand the importance of taking enough medicine for the painful physical therapy needed to restore full range of movement. He also pointed out that it was important to stop the pain medication if I ever found myself wanting to take a pill when I didn't have pain yet, but thought it might start soon. That was the signal to stop all together. His guidance worked for me. 
Managing pain medication is even harder for individuals whose pain isn't associated with short-term healing. Chronic pain is the hardest to control.
UNLV School of Medicine pain medication curriculum
Unlike the medical student highlighted in the NPR story, our students will get much more than a few hours of lectures on pain management and addiction. We designed our four-year curriculum to ensure our students recognize addiction, prescribe the right amount of pain medication for their patients, and manage their patients' pain treatment.
Here is the UNLV School of Medicine's comprehensive plan for its four-year curriculum related to addiction.
Year 1
  • Definition of acute and chronic pain
  • Definition of addiction
  • Public health aspects of chronic pain and addiction
  • Taking a pain history
  • Recognition and treatment of an overdose
  • Basic pharmacology of opioids
  • Opioid side effects and treatment
  • Cancer pain
  • End-of-life pain and treatment
  • Musculoskeletal pain
  • Facial pain and headache
  • Visceral (internal organ) pain
  • Addiction during pregnancy
  • Medical complications of addiction
Year 2
  • Pain pathways
  • Infections associated with drug abuse
  • Treatment of opioid addiction
  • Role of physician in behavior change
  • Role playing exercises in patient counseling
Year 3
  • Prescription drug abuse
  • Classification of pain
  • Patient education about pain
  • Opioid dosing strategies
  • Shadowing of a pain patient
  • Addiction in special populations like pregnancy, geriatric populations, and adolescents
  • Non-substance addictions (gambling, sex, food, etc.)
Year 4
  • Treatment of acute and post-op pain
  • Transitions of care and referral to substance use disorder treatment centers
  • Ethical issues in pain treatment
  • Legal and regulatory issues in pain treatment
UNLV School of Medicine is committed to addressing addiction in Las Vegas. It's one of the five social issues we're focusing on to improve health care in our region. In addition to our four-year curriculum, we're tackling the problem through community outreach, research, and special projects. We believe that our efforts will soon turn those troubling statistics around and improve the pain management care our community receives.
Best wishes,
Medical Residencies: Shaping the future of health care in Southern Nevada

RSVP today for panel discussion on Nevada's residency programs. Join Dr. Barbara Atkinson, Dr. Mark Penn, founding dean Roseman University College of Medicine, and Dr. John Dougherty, dean, Touro University as they discuss what's needed at the state and federal level to grow the state's residency programs. The p rogram starts at 4:30 pm Thursday, August 18 at Roseman University.
Gary Larson interviews Tracey Green, MD on improving public health in Las Vegas
Public health is a concern for communities across the country. Gary Larson, radio host for 91.5 talked to Dr. Tracey Green, Vice Dean for Clinical Affairs for UNLV School of Medicine to learn how the school is educating the next generation of practitioners. Dr. Green discussed efforts already underway to improve the health of members of our community. Listen here.

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