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Clin Pharmacol Ther. 2018 Jan 9. doi: 10.1002/cpt.1015. [Epub ahead of print]

Changing Prescribing Behavior in the United States: Moving Upstream in Opioid Prescription Education.

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Department of Behavioral Science, University of Kentucky.


In the U.S., deaths from prescription opioids have quadrupled since 1999, prompting authorities to declare an "opioid abuse" crisis. Rising overdose deaths were attributed to trends in the over-prescription of opioids, specifically the strength and duration of the initial prescription. We describe educational interventions designed to control health care professionals' (HCP) opioid prescribing in the wake of this crisis. A review of relevant programs for practicing providers, medical residents, and medical students reveals a focus on educational interventions that we describe, borrowing from sociologist John McKinlay's metaphor for public health interventions, as "downstream." These downstream interventions concentrate on regulating and educating practicing HCPs rather than transforming the training environment for medical students and residents. We draw on theories of behavior change to call for the development of complementary "upstream" educational programs for future practitioners that focus on structural and psychosocial factors and may contribute to more sustainable behavior change outcomes. This article is protected by copyright. All rights reserved.


medical education; opioid prescription education; spiral curriculum; upstream

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