A Student's Call for Medical School Wellness Curriculums to Include Harm Reduction

Substance use among medical students is high, has had fatal consequences, and continues postgraduation, with substance use rates among physicians being higher than the general population. Unfortunately, many institutions lack specific policies on substance use, have policies centered on punitive and disclosure-prohibitive approaches, or students are unaware of such policies. Notably, though physical and mental wellness are typical components of medical school curricula and policy, student substance use is often glaringly absent. As a result, schools can be unprepared to address substance use and students can be left feeling unsupported as they grapple with their evolving role in medicine-some of whom may use drugs during this time. Reasons for the shortcomings in addressing student substance use are multifactorial, with stigma, dwindling preclinical time, and overconfidence possibly playing a role. To address this problem, schools must integrate into their undergraduate medical wellness curricula a harm reduction framework that (1) includes student perspectives and input, (2) changes school culture, and (3) improves access to harm reduction education and resources as well as substance use and mental health treatment. Preparing students for their own interactions with alcohol or drugs must be a priority, especially as they enter a profession with a multitude of overlapping risk factors for unhealthy alcohol and drug use, and this must be done in a destigmatizing, supportive, and compassionate way.