Perception of opioids among medical students: unveiling the complexities and implications

Methods

Results

The study sample consisted of 377 medical students, specifically from OU-HCOM and UT (Table 1). Among these participants, the majority, comprising 312 individuals (82.7 %), were affiliated with OU-HCOM. Of the total sample, 221 participants (58.6 %) were aged 25 years or older, and 214 participants (56.7 %) identified as female. When considering the participants’ stage in their medical education, a significant portion (280 individuals [74.2 %]), were in their preclinical years, encompassing the first and second years of medical school.

The average level of agreement for the participants was plotted based on their responses to various questions about their experiences and how they perceived the impact of opioids (Table 2). The majority of participants disagreed that opioids had affected their nuclear family, circle of friends, or the community where they reside. The average level of agreement for opioids impacting participants’ immediate family was 1.9 (95 % CI, 1.8–2.0), and for impacting their circle of friends, it was 2.3 (95 % CI, 2.2–2.5). Regarding the impact on the community where participants reside, the average level of agreement was 2.4 (95 % CI, 2.3–2.5). Interestingly, participants generally agreed that opioids had impacted someone in their training program, with a mean of 4.1 (95 % CI, 4.0–4.2), but that they had not treated a patient with acute opioid overdose, with a mean of 2.4 (95 % CI, 2.2–2.5).

The average perception that participants had on the impact of opioids’ severity was determined (Table 3). Participants perceived the impact of opioids on Ohio’s adult population to be greater than the impact on Ohio’s minors. The severity score average for adults was 74.3 (95 % CI, 72.4–76.3), while for minors, it was 65.6 (95 % CI, 63.3–67.9). Of note, one of the lowest rated areas was the impact on their profession’s ability to provide quality work, which had an average score of 66.4 (95 % CI, 64.1–68.8) – even though the impact on Ohio’s healthcare systems was rated as the second most severe on the questionnaire, with an average score of 80.4 (95 % CI, 78.8–82.0). Moreover, when comparing severity ratings among rural, suburban, and urban areas, the highest severity was reported in rural communities, with an average score of 80.7 (95 % CI, 78.8–82.6).

The perceived severity of the opioid impact on Ohio’s adult population was compared between participants who were immediately impacted and those who were not. The results were plotted in a bar chart. Of the 377 participants, 129 (34 %) stated that opioids impacted their nuclear family or circle of friends, indicating that they were immediately impacted. The mean severity score for participants immediately impacted was 77.3 (95 % CI, 74.0–80.5). However, for those not immediately impacted, it was 72.8 (95 % CI, 70.5–76.2). The t test illustrated a significant difference in perceived severity for participants in these two groups (p=0.03, α=0.05).

Furthermore, when comparing participants who were secondarily impacted by opioids with those who were not, the mean severity score was 75.4 (95 % CI, 73.4–77.5) and 68.7 (95 % CI, 63.5–73.9), respectively. Similarly, the t test demonstrated a significant difference in perceived severity between these two groups (p=0.02, α=0.05).

The perceived stigma of opioids was compared for participants immediately impacted and those who were not. The results were plotted in a bar chart. Participants who were immediately impacted disagreed with the statement that opioid addiction is a symptom of poor moral character, with a mean rank of 1.5 (95 % CI, 1.4–1.6). Participants not immediately impacted were closer to neutral, with a mean rank of 1.6 (95 % CI, 1.5–1.7). The t test did not illustrate a significant difference in stigma associated with opioid users for participants that were immediately impacted by opioids and those who were not (p=0.3, α=0.05).

The correlation between the drug overdose rate and perceived severity score for Ohio counties was assessed utilizing the Kendall rank test. The results of the test did not indicate a significant relationship between perceived severity and the drug overdose rate (R=0.05, p=0.6, α=0.05).

Discussion

This study assessed medical students’ beliefs, experiences, and perceptions of the opioid crisis. Such insights are crucial because these future physicians will play a significant role in addressing the challenges faced by individuals struggling with opioids.

First, it is important to see how the lives of medical students have been impacted by opioids. The study’s findings indicate that the impact on medical students’ nuclear families or their circle of friends is relatively less compared to the impact on individuals in their training program or the community where they reside (Table 2). Comparing these two groups reveals the disparity in how immediate or indirect exposure to the opioid crisis influences medical students’ perception of its severity. As previously stated, those immediately impacted by the opioid crisis were statistically more likely to see the crisis as severe compared to those without such a direct impact. Likewise, those secondarily impacted showed a statistically significant difference in their perception of severity when compared to individuals who were not. Recognizing this variation in severity outlook due to personal experience could lead to significant changes in the medical curriculum, aiming to provide comprehensive education on the severity of opioids to students from diverse backgrounds.

However, it is important to distinguish between perceived severity and stigma. As future physicians, harboring a stigma toward individuals involved in the opioid crisis could potentially lead to unsatisfactory care for that patient due to potential implicit biases. Encouragingly, the results from this study show that there is no statistically significant difference in the level of stigma between those who were immediately impacted by the crisis and those who were not. In fact, survey responses revealed that students rated the impact of opioids on their capacity to deliver quality patient care as the second lowest concern, while ranking the impact of opioids on the healthcare system as the second most severe (Table 3).

In addition to personal experiences, the experiences gained throughout medical school have a significant influence on perceptions of opioids. While this study deals predominately with analyzing how personal experiences contribute to the perceptions of opioids held by medical students, literature can offer insight into how experiences gained throughout medical school can also contribute to beliefs. Previous research indicates that a patient panel has led to a change in approximately 70 % of students’ perceptions of individuals with substance use disorders (n=369) [10]. The same study stated that the patient panels shifted student attitudes, due to the power of hearing real patient stories, toward a more humanistic perspective and exploring more alternative treatment options [10].

Another study found that first-year medical students identified pain as a major concern in their early clinical experience [11]. Students’ perceptions of pain-related encounters, combined with the results of this study that deal with medical students’ personal experiences with opioid use, can inform curriculum design and ultimately benefit both physicians and the patients [10, 11]. For example, additional lectures on holistic medicine and alternative treatments for pain management, such as OMT, could enhance patient care.

This study also explored medical students’ perceptions of the areas within society where they believe the opioid crisis is most severe. The perceived impact on the adult population was greater than that on the minor population (Table 3). However, opioid use disorders (OUDs) and adults ultimately impact the minor population [12]. Children and adolescents who grow up in households with OUDs experience an increased risk of mental health problems, accidental opioid poisoning, substance use disorder, and family dissolution that results from parents’ incarceration, foster care placement, or loss of parent to an opioid overdose [13]. Additionally, the impact on the rural community was greater than that on either the urban or suburban communities (Table 3). The literature reinforces this idea that those in rural communities are more likely to misuse opioids [14, 15]. One study found that the lack of behavioral health and recovery resources in rural communities creates barriers to effectively manage OUD and chronic pain [16].

In order to alleviate the opioid crisis, outreach programs aimed at enhancing healthcare access can play a vital role in benefiting these regions [17]. Another possible solution is to expand medical school classes, and therefore have more graduating physicians who are able to serve those communities that are disproportionately affected by OUD. Alongside this expansion, there also needs to be additional training provided to these physicians that reinforces the notion that OUD is a chronic disease that requires it to be treated as such.

By utilizing this valuable information, medical institutions can adapt their curriculum and equip future physicians with a comprehensive understanding of the severity and intricacies surrounding opioid use and addiction. For example, medical schools can reiterate that treatment, and recovery from OUD includes more than just medications. Medical students may benefit from learning about nonpharmacologic alternatives to pain management, such as OMT, and incorporating the osteopathic philosophy of holistic medicine that addresses mental health. This expanded knowledge base enables medical students, regardless of their backgrounds, to develop the necessary skills and expertise to address the challenges posed by opioids in their future practice. With an enhanced understanding of the crisis, these future physicians are better prepared to provide effective prevention, treatment, and support to individuals affected by opioid addiction. Consequently, their contribution to the ongoing fight against the opioid crisis becomes more significant and impactful, fostering positive patient-centered relationships.

Study limitations include the small sample size from two institutions, self-reported data, and the cross-sectional study design. Data collection occurred exclusively at one osteopathic medical school and one allopathic medical school in Ohio, thereby constraining the generalizability of the findings to all medical students. Moreover, the smaller sample size from the allopathic medical school further hinders broad generalizations to allopathic medical students, although it is essential to acknowledge that this medical school’s class size is half that of the osteopathic medical school. Additionally, the self-reported data collected are vulnerable to social desirability bias. To minimize bias, we informed all participants that their responses were anonymous. Finally, the cross-sectional study design prevents discerning causality. Future research should examine osteopathic and allopathic medical students’ experiences and beliefs about the opioid crisis throughout their medical education and postgraduation to identify predictors for individuals most likely to provide treatment to people with OUD.

Conclusions

The findings of this study revealed a diverse range of backgrounds among students, highlighting distinct levels of exposure to the crisis, ranging from direct encounters to minimal experiences. Interestingly, a significant majority of students had greater exposure to the crisis through classmates or patients rather than family or friends. It was particularly noteworthy that individuals who had personal encounters with the crisis, especially through family or friends, tended to perceive the severity of the situation as more pronounced compared to those without such immediate impacts. Despite variations in perceived severity based on personal encounters, the study revealed that these differences did not necessarily translate into variances in the stigma attached to individuals grappling with opioid-related challenges. The study’s insights underscored the nuanced perspectives held by students, suggesting that the impact of the crisis was shaped by diverse and multifaceted influences. The prevalence of indirect exposure through classmates and patients emphasized the broader societal implications of the crisis and its reverberations within academic and healthcare settings.