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, ηp 2 = .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.