How a Medication for Opioid Use Disorder Curriculum Translates into Experiences and Internal Medicine Residents' Understanding of Patients with Opioid Use Disorder.

PROBLEM: The number of people with an Opioid Use Disorder (OUD) continues to outpace access to associated medication. Ninety-six percent of states report higher rates of OUD than access to medications, and, despite being the standard of care, only 3% of physicians currently prescribe medication for opioid use disorder (MOUD). Prior studies have shown that decreasing barriers, such as a lack of knowledge about MOUD, increased physicians' willingness to prescribe. However, most internal medicine residency programs do not have a required addiction curriculum. As a result, we created a curriculum and conducted qualitative interviews with residents to better understand experiences with the curriculum. INTERVENTION: In an effort to overcome physician-centered barriers associated with prescribing MOUD, we developed and implemented a week-long curriculum, Addiction Week, for second and third year Internal Medicine Residents at Indiana University School of Medicine in a safety-net clinic. The curriculum included the following: didactics on substance use disorder (SUD), including OUD and alcohol use disorder, and MOUD (mostly buprenorphine), and mostly web-based, peer-reviewed and guideline based readings about addiction, direct observation of addiction counselors, direct discussion with people receiving MOUD, observation of a group therapy session, informal discussion with providers who prescribe MOUD, and, for some residents, observation of a physician prescribing MOUD. After completing the curriculum, the residents participated in an hour long audio-recorded interview to better understand their experiences with the curriculum. CONTEXT: This study was completed at a residency program where residents were not previously exposed to outpatient MOUD prescribing. Due to limited availability of faculty treating patients with MOUD, residents spent the majority of their time shadowing a social worker. IMPACT: Residents described gaining a deeper understanding of OUD by having the opportunity to interact with patients in a stable outpatient setting, which for many led to increased confidence and willingness to prescribe MOUD for people with OUD. LESSONS LEARNED: The greater understanding of addiction and willingness to prescribe MOUD described by residents in this study indicate that this type of curriculum may be a promising way to increase MOUD prescribing. Further studies are needed to evaluate whether this intervention can change prescribing behaviors.Supplemental data for this article is available online at https://doi.org/10.1080/10401334.2021.1897597.

Kid in the middle: a discussion of effectiveness of center rear-seat restraint systems.

This paper examines effectiveness of rear seat restraint systems in reducing injury in frontal and side impacts. Results indicate effectiveness varies by crash configuration and occupant age, with age being the most important factor influencing odds of fatality/serious injury to belted, rear seated occupants in frontal and side crashes. There is no significant difference between center lap and outboard lap/shoulder belts effectiveness; however, field data shows a high percentage of misuse (wearing belts improperly or using age-inappropriate belts) associated with fatalities and serious injuries. Review of NASS/CDS cases on seriously injured belted children shows belt misuse and injury patterns that might be mitigated by booster seats or proper use of adult belts.