Study: School clinicians need more training in opioid misuse interventions

A study from the University at Albany School of Public Health found that school-based health center providers lack the training and confidence to successfully deliver opioid misuse interventions.

Brett Harris, clinical associate professor in the University's Department of Health Policy, Management and Behavior, surveyed school-based health center providers from New York in late 2019 to explore their attitudes, perceptions and practice of upstream prevention of opioid misuse. "Upstream prevention" refers to activities and interventions that reduce health risk behaviors early on before conditions and consequences become more severe.

Results showed that most middle and high school-based health center clinicians, while recognizing the severity of the opioid crisis in general, did not see opioid misuse or overdose as a high risk among the students they serve. In addition, more than half (51 percent) reported they did not have the skills to address opioid misuse, and 66 percent said they lacked the confidence to prevent opioid misuse and overdose. In addition, 37 percent noted that the greatest barrier to addressing opioid misuse was that adolescents face more pressing health concerns.

"Far fewer adolescents have opioid use disorders than adults, which is why it is logical to assume that adolescents face more pressing health concerns. But school-based health center providers do have a role to play," says Harris.

"When it comes to the opioid crisis, much of the focus has been on downstream efforts such as overdose reversal and medication-assisted treatment," Harris says. "From a public health perspective, more focus is needed upstream."

Harris describes the process known as "screening, brief intervention and referral to treatment" (SBIRT) with adolescents as a critical upstream approach in a multi-tiered strategy for combating the opioid crisis. Through universal screening for substance use—particularly alcohol and marijuana which often precede opioid misuse among youth—the next generation of individuals with opioid use disorder will be greatly reduced.

Fewer than half of survey respondents were familiar with SBIRT, but after an introduction to the model, three quarters agreed that implementing SBIRT to reduce other risky behaviors such as alcohol and marijuana use may be an effective way to combat the opioid crisis.

"This study is the first of its kind to explore these constructs among pediatric providers, and it is critical that we better understand them as we formulate a public health approach to addressing the opioid crisis," says Harris.