Substance Use Disorder Education for Students and Residents

To minimize the harmful effects of licit and illicit drug use on patients and communities, the AAFP believes all students and family medicine residents should receive comprehensive education on how to:

Use screening tools to screen for and diagnose the full, multi-faceted spectrum of substance use disorder (SUD).
Provide counseling and prescribe evidence-based treatment modalities for SUD.
Identify each patient’s medical, psychological, social, and economic complications of SUD and link them to appropriate resources.
Recognize the social inequities that affect patients’ capacity to understand and effectively cope with drug-related harm.
Implement harm reduction strategies to meet patients where they are at, affirm the patient as the primary agent of change for their drug use, and address individual and community conditions of substance use.
Break down the stigma often associated with patients with SUD and help build a non-judgmental and inclusive environment.
Advocate on behalf of patients with SUD as representatives of medical society to pertinent legislative and municipal bodies.
Create space for the voice of people who use drugs to be heard when developing programs and policies.
Follow clinical standards and utilize monitoring programs to minimize the risk of SUD when prescribing high-risk medications.

For students and family medicine residents to be competent in the knowledge, skills, and attitudes listed above, SUD must be prioritized as a core subject within undergraduate medical education (UME) and graduate medical education (GME). Didactics, case discussions, simulation, engagement with community organizations supporting people with SUD and implicit bias training can be used to teach SUD fundamental concepts and curricular topics, including but not limited to:

The primary a priori assumption that everyone wants to be healthy.
Definitions for, epidemiology of, and differences between substance use, tolerance, dependence, and substance use disorders.
History of drug policies in the U.S. and their impact on access to care, health inequity, and structural racism, classism, and sexism.
Core biological, psychological, and social frameworks of addiction and dependency.
Precipitants and factors that interfere with SUD treatment and referrals for services, including the impact of trauma (including adverse childhood experiences) and concurrent physical, mental, and social health conditions.
Intersectionality of SUD with race, gender, sexual orientation, and culture.
Pharmacologic and non-pharmacologic SUD treatment options, including medication-assisted treatment in combination with counseling and behavioral therapies.
Foundational principles central to harm reduction to reduce negative consequences associated with drug use and build respect for the rights of people who use drugs.
Evidence-based public health strategies to reduce harm, such as overdose prevention, syringe service programs, and safer drug use.
Recovery models for SUD, incorporating a holistic, supportive, and optimistic approach.
Person-centered care that uses non-stigmatizing language, centers on the premise that there can be difficult conversations rather than difficult patients, and incorporates motivational interviewing and shared-decision making.
Evidence-based screening tools for nonmedical use of prescription drugs, prescription drug monitoring programs, and patient-centered clinical practices that consider all treatment options, monitor risks, and safely discontinue high-risk medications.

To successfully train and produce knowledgeable and skilled physicians in preventing, screening, diagnosing, and treating SUD, UME and GME faculty must be equipped and supported. Leaders at UME and GME institutions should ensure core faculty are appropriately trained to 1) teach and role model the knowledge, skills, and attitudes they are attempting to impart to their learners surrounding SUD assessment and management, 2) tailor the SUD curriculum to meet the needs of the communities they serve and specific practice settings implicated at a local level, 3) facilitate dialogue that explores values and cultural norms related to drug use and drug-related stigma, and 4) stay current in the comprehensive approaches used for SUD diagnosis and management as they evolve. (April 2022 BOD) (September 2022 COD)