The Toxicologist as Educator: Addressing Pain Management in the Midst of an Opioid Epidemic

Abstract

We call it the Bmonthly rant^at the Oregon and Alaska Poison Center: a rotating student or resident presents a case of an opioid poisoning and a well-prepared overview of the toxicokinetics and toxicodynamics of opioids in overdose. The eyes of the fellows and attendings meet briefly, and the moment is perfect for an in-depth discussion about the complexities of opioid prescribing, pain management, and pitfalls of opioid therapy. What ensues is a carefully designed discussion surrounding several key components of appropriate pain management and iatrogenic addiction. With an increasing focus on the opioid epidemic and prevention of addiction, medical educators are actively working to design pain management curricula. It is worth highlighting that many toxicologists already incorporate this education for rotators on the toxicology service and that toxicologists are a valuable resource for medical educators involved in the re-designing of medical curricula.The toxicology rotation seems an ideal place to formally educate trainees to manage pain while attenuating diversion, adverse effects, polypharmacy, and iatrogenic addiction. Whether students and residents spend a day, a week, or a month on the toxicology service, educators can use this opportunity to introduce new approaches toward opioid use in pain management, thus laying the groundwork to reduce morbidity and mortality from opioids. Participants in the discussions on our service typically include third or fourth year medical students, pharmacy students, and emergency medicine residents on their toxicology rotation, who will go on to treat patients with acute and chronic painful conditions in all fields of medicine. Even early in training, students and residents make astute observations about the challenges and pitfalls surrounding the management of acute and chronic pain.Promoting awareness and introducing a primer for good prescribing habits early in training may have a significant impact on the future practices of rotators. One way to do this is to review four key aspects for providing care to the patient with an acute or chronically painful condition. The simplest approach is to integrate this review during toxicology rounds where trainees already participate in opioid exposure and overdose case discussions.