Learning to Help Doctors Curb Opioid Deaths

When Elizabeth McCarthy and Jonathan Freise began medical school at UCSF in 2016, the opioid epidemic was making daily headlines. Every day in the US, around two dozen people were dying from overdoses involving prescription opioids. As future leaders in medicine, the students couldn’t look away. They knew they had to do something. 

To prevent overdose deaths, the US Centers for Disease Control and Prevention recommends that doctors prescribe the drug naloxone – better known by the brand name Narcan – for patients taking high-dose opioids for chronic pain. Administered as a nasal spray or intramuscular injection, naloxone quickly reverses the effects of opioids, which can slow or stop breathing when taken in high doses. By keeping naloxone on hand in case of an overdose, patients have a better chance of surviving. 

Yet despite naloxone’s proven benefit, studies show that primary care physicians often fail to prescribe the drug with opioids. McCarthy and Freise decided to help change that – starting with their home clinic in the Division of General Internal Medicine at UCSF Medical Center Mount Zion. That’s where, in 2012, Scott Steiger, MD – now an associate professor in the division and deputy medical director of the Opiate Treatment Outpatient Program at Zuckerberg San Francisco General Hospital – had set up a database to track opioid prescriptions. 

As part of UCSF School of Medicine’s pioneering Bridges Curriculum, students team up with clinicians right off the bat. A highlight of this unique curriculum is the Clinical Microsystems Clerkship, in which first-year students learn skills to improve clinical outcomes and devise solutions to some of the most pressing challenges facing health care systems. “Before they have written a prescription, sought consent for a procedure, or admitted a patient, our medical students have already helped improve care,” says John Davis, MD, PhD, associate dean for curriculum and an associate professor in the UCSF Division of HIV, Infectious Diseases, and Global Medicine. 

Working with faculty mentors Michelle Guy, MD, a professor in the Division of General Internal Medicine, and Leslie Sheu, MD, an assistant professor in the same division, McCarthy and Freise set out to increase naloxone prescriptions at the Mount Zion clinic. First, they surveyed doctors to learn why they didn’t always prescribe the drug. The doctors’ most common reasons? They either didn’t have time or didn’t want to risk stigmatizing patients by suggesting they were likely to overdose.  

So McCarthy and Freise devised a solution. Drawing from information in Steiger’s database, they sent a tailored email to each doctor suggesting ways to discuss naloxone with their patients on high-dose opioids. To save the doctors’ time, the students worked with medical assistants to queue naloxone prescriptions in the patients’ medical records prior to their next visits. As a result, the percentage of naloxone prescriptions for these patients doubled, from 28 percent to 56 percent.  

This success is just one of many examples of the transformative work that UCSF medical students do as part of the Clinical Microsystems Clerkship. Today’s students are helping more people quit smoking, getting more patients screened for cancer, and making intensive care more efficient, among other efforts to advance care at training sites across San Francisco.  

“Thanks to our talented faculty mentors and the invaluable support of our donors, our students are helping save lives and improve the experiences of patients and health care providers,” says Catherine Lucey, MD, executive vice dean and vice dean for education in the School of Medicine.