Federal certification enables Brown med school graduates to treat opioid use disorder nationwide

Warren Alpert Medical School Class of 2020 graduates will be the first in the nation to graduate with training that allows them to prescribe medications to treat opioid use disorder in any U.S. state.

PROVIDENCE, R.I. [Brown University] — With a curriculum newly certified by the Substance Abuse and Mental Health Services Administration, graduates of Brown University’s Warren Alpert Medical School will now be equipped with the training necessary to prescribe in all 50 states medications that can help to treat opioid use disorder.

The Drug Abuse Treatment Act of 2000 (DATA 2000) requires physicians to obtain a waiver to prescribe FDA-approved medications including buprenorphine and Suboxone, commonly used in medication-assisted treatment (MAT). With the training they receive in medical school, new physicians will be able to apply for the waiver once they graduate, earn a full medical license and complete U.S. Drug Enforcement Administration registration.

While the training has been in place at Brown’s medical school for two years, the ability to obtain a waiver had applied only to graduates practicing in Rhode Island. After being certified by the Substance Abuse and Mental Health Services Administration (SAMHSA) in late 2019, it now applies to those practicing anywhere in the U.S.

“We’re the first school to do this,” said Dr. Sarita Warrier, assistant dean of medical education. “We feel like we’re really pushing the opioid use disorder curriculum forward — not just here at Brown, but it’s moving the national view of such curricula as well.”

Thanks to federal legislation signed by President Donald Trump in 2018 — the SUPPORT for Patients and Communities Act, based in part on research from the Warren Alpert Medical School — any medical school curriculum certified by SAMHSA can count for DATA 2000 waiver training.

We’re the first school to do this. We feel like we’re really pushing the opioid use disorder curriculum forward — not just here at Brown, but it’s moving the national view of such curricula as well.

Dr. Sarita Warrier Assistant Dean of Medical Education

SAMHSA’s backing is what helped turned the school’s extensive opioid use disorder curriculum into the first waiver program of its kind in the country, Warrier said.

“This is definitely a stamp of approval,” she said. “One of SAMHSA’s goals is to help physicians provide better care to patients with substance use disorders, and this certification is their way of saying we’re doing just that.”

Last year, every Warren Alpert Medical School graduate qualified to receive the waiver to prescribe MAT in Rhode Island. For the Class of 2020, every graduate will complete the same requirements, and roughly 40 will complete the training necessary to prescribe nationwide, which was made optional this year. By 2021, every graduate will be qualified to prescribe MAT in all 50 states.

While not every graduate will find themselves needing to prescribe medications like suboxone, many will — especially in fields like family medicine, internal medicine, psychiatry and emergency medicine.

“It’s so important that we increase the pool of physicians who will be able to reach out to their patients,” Warrier said. “It’s such a crucial way of increasing access.”

In implementing the training as a standard part of the curriculum, Associate Dean of Medical Education Dr. Paul George said medical school leaders hope to not only remove barriers that patients face in receiving treatment, but also those that physicians may face in qualifying for a DATA 2000 waiver.

Unlike at Brown, training for the DATA 2000 waiver typically is not available to doctors until they are practicing, which presents a challenge to physicians who may not be able to complete the additional training given the other demands of practicing medicine.

“We don’t need a special certification to provide hypertension medication for those with high blood pressure, or to provide insulin to diabetics, or even to provide hydrocodone for patients in pain,” George said. “But for some reason, we need it to prescribe MAT to treat opioid use disorder. My hope is to remove that obstacle.”

The Warren Alpert Medical School’s full curriculum on opioid use disorders — a four-year, integrated approach recognized in 2018 with an Association of American Medical Colleges innovation award — has been in development since 2015. That year, the school received a grant from SAMHSA to train students in Screening, Brief Intervention and Referral to Treatment (SBIRT), an evidence-based practice used to identify, reduce and prevent opioid misuse.

Over the years, it has expanded not only to include the waiver certification, but new components such as workshops, clerkships and collaborations with nursing, pharmacy and social work students. The school is currently developing new programs aimed at boosting clinical experiences and teaching students best practices on prescribing MAT and keeping patients on track, George said.

“It’s a constant evolution,” he said.

Other schools are taking notice. George said that over the course of developing the curriculum, he’s been in touch with roughly 30 other medical schools who are looking to emulate what is now in place at Brown — a critical step in combatting the opioid epidemic nationwide.

“We’re hopefully making an impact on the number of deaths from overdose,” George said. “We may not see it for a few years until our graduates start going out into the world and treating their own patients, but that’s ultimately the result we’d like to see.”