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    Dentistry and the opioid epidemic: what you need to know

    Taking a look at the role the dental industry plays in the opioid overdose crisis and what dentists can do about it.

    Almost every day it seems there’s a headline on America’s opioid overdose crisis. And for good reason: More than 115 people in the United States die every day after overdosing on opioids, according to the National Institute on Drug Abuse. And in October 2017, President Donald Trump declared the opioid epidemic a national public health emergency.

    The start of the opioid crisis can be traced back to the late 1990s when healthcare providers began to prescribe opioid pain relievers at greater rates, after being reassured that patients wouldn’t develop addictions. This in turn led to widespread misuse of those medications. According to the NIH, roughly 21 to 29 percent of patients prescribed opioids for chronic pain misuse them.

    Opioids include a range of drugs, from licit prescription pain relievers like oxycodone, codeine and fentanyl to the illicit drug heroin. In addition to causing an increased overdose death rate, opioid addiction contributes to the spread of infectious diseases as well as the rising incidence of neonatal abstinence syndrome.

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    The dental industry plays a small yet significant role when it comes to the opioid epidemic. In 1998, dentists were the top specialty prescribers of opioid pain relivers, accounting for 15.5 percent of all opioid prescriptions in the nation, according to the American Dental Association. Fortunately, by 2012, this number had fallen to 6.4 percent. Nevertheless, dentists are typically one of the first medical professionals to prescribe opioids to teens and young adults for the treatment of acute pain, such as prescribing Vicodin or Percocet after wisdom teeth removal.

    “When we think about what the dentist’s role is, in my mind, we may not be prescribing that much, but we are likely to be somebody who is prescribing to a person who has never had an opioid before,” says Paul A. Moore, BS, DMD, MS, Ph.D., MPH, a professor at the University of Pittsburgh School of Dental Medicine and a spokesperson for the ADA. “If you’re the first prescriber, you need to stop and do some counseling, do some history taking to see if they’re at risk. And when you prescribe to an adolescent, you just have to stop and think that in adolescents, their central nervous system isn’t fully developed, and as a function of that they’re frequently risk takers.”

    In light of the growing opioid overdose crisis, the ADA this March announced a new policy to combat the opioid epidemic. The policy supports mandatory continuing education in prescribing opioids and other controlled substances; statutory limits on opioid dosage and duration of no more than seven days for the treatment of acute pain; and dentists registering with and utilizing Prescription Drug Monitoring Programs (PDMPs) to promote the appropriate use of opioids.

    “As president of the ADA, I call upon dentists everywhere to double down on their efforts to prevent opioids from harming our patients and their families,” says ADA President Joseph P. Crowley, DDS, in a statement. “This new policy demonstrates ADA’s firm commitment to help fight the country’s opioid epidemic while continuing to help patients manage dental pain.”

    Dr. Moore says PDMPs have been particularly effective, especially in states that make their use mandatory.

    Opioid epidemic“Starting about four years ago, states began to set up systems whereby if you have a patient come into your office who is in acute pain or is possibly in acute pain and you want to write a prescription for Vicodin, you can call a telephone number and that number has a database that can tell you whether that patient has received a Vicodin or a narcotic in the last two weeks or the last month,” Dr. Moore explains. “So, now you have some knowledge of whether this patient is doctor shopping or not.

    “About a year ago, every state has a PDMP that’s linked into pharmacies,” he adds. “The pharmacies, when they dispense an opioid, they report that they’ve just dispensed 30 tabs of Vicodin to Mr. Jones. And so now I know, when that patient comes into my office, whether this is a legitimate prescription or whether this is someone who is misusing opioids.”

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    Dr. Moore says that all dentists may not be thrilled with the ADA’s new policy, but that it’s necessary given the current state of the opioid epidemic in the country.

    “None of us want a legislator making a decision on how I’m going to treat a patient or how I’m going to write a prescription, but this addiction is pretty traumatic. It’s terrible what’s going on,” he says.

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    Kristen Mott
    Kristen Mott is the associate editor for Dental Products Report and Digital Esthetics.


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