A Case-Based Curriculum on Buprenorphine for Treatment of Opioid Use Disorder Among Internal Medicine Residents

Abstract

Background: As the mandatory X-waiver requirements for prescribing buprenorphine have recently been lifted, general practitioners are being relied on to fill the treatment gap in prescribing medications for opioid use disorder (MOUD). However, insufficient clinician education remains a major barrier to prescribing MOUD in both inpatient and outpatient settings. Objective: To evaluate the impact of a new MOUD curriculum on internal medicine (IM) residents’ attitudes, comfort, and knowledge of buprenorphine in the inpatient and outpatient settings. Methods: All second-year IM residents (n = 46) participated in a 90-minute curricular session between July and October 2022 during scheduled mandatory didactic blocks. The curriculum was structured as a small group, case-based session focused on how to initiate sublingual buprenorphine (traditional and low-dose initiation). Residents completed identical and anonymous pre- and post-session surveys. A Wilcoxon signed rank test was used to analyze the data. Results: Thirty-nine (84.4%) second-year IM residents participated in the evaluation. Residents reported increased importance of independently initiating buprenorphine for hospitalized patients with opioid withdrawal ( P < .001). Residents were significantly more likely to endorse confidence in discussing MOUD with patients ( P < .001), initiating buprenorphine in inpatient and outpatient settings ( P < .001), and identifying patients who would benefit from low-dose buprenorphine initiation ( P = .002). There was a significant increase in the correct number of knowledge-based questions after the session (before = 1.55/4 vs after = 3.33/4; P value < .001). Conclusions: A 90-minute buprenorphine training improved residents’ attitudes toward, perceptions of competency, and knowledge of buprenorphine delivery to patients with OUD in the inpatient and outpatient setting.