10 Feb Dentists Can Help Turn Around Opioid Epidemic

MedicalResearch.com Interview with:

Dr. Suda

Katie J. Suda, PharmD, MS
Study Principal Investigator
Professor of Medicine
University of Pittsburgh School of Medicine 

MedicalResearch.com: What is the background for this study?

Response:   Dentists are one of the top prescribers of opioids; prescribing 1 in 10 opioids in the United States. Dentists also prescribe a lot of opioids to adolescents and young adults which are a high risk population for substance misuse. This is especially true because studies have shown that non-opioid pain medications are similar or more effective for the treatment of oral pain.

MedicalResearch.com: What are the main findings?

Response: Dentists treat a lot of pain – we have all probably had the experience of a terrible tooth ache. However, our results show that US dentists prescribe opioids more frequently and in excessive quantities than is likely needed. In a sample of 550,000 dental visits from commercially insured adults, approximately half of opioids prescribed on the same day as a dental visit exceeded CDC guidelines for acute pain management. 1 in 3 opioids were prescribed at dental visits were the pain intensity post-dental visit was anticipated to be mild. Young adults, men, and those receiving oxycodone were more likely to receive excessive quantities of opioids. This is concerning because these groups have a higher risk of opioid-related overdose. 

MedicalResearch.com: What should readers take away from your report?

Response: When receiving dental care, patients should talk to their dentists if they need an opioids post-procedures or if non-opioid pain medications will be effective. It has been reported that US dentists have an over-perception of the level of pain associated with dental procedures compared with what is actually experienced by their patients. Patients should also ask their dentist for a contingency plan; what to do if the pain medication does not provide adequate pain relief. This contingency plan should include drug and non-drug remedies (e.g, ice) and when to call the dentist (severe pain, fever).

If patients do have opioids at home leftover from a previous prescription, they should take leftover opioids to a medication take-back program. Leftover opioids have been a source for persons that misuse opioids.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response:  Medical clinics are not the same as dental clinics. Thus, we need to determine what strategies would assist dentists in judicious prescribing of opioids.

Unfortunately, US dentists do not have guidelines to help them decide which medications to prescribe to patients. Similar to medical providers, dentists need to be provided resources to aid in their prescribing decisions for pain medications. This should include clinical guidelines specific to oral health and education on how to talk to their patients about treating their oral pain. Dentists should be included as part of the solution needed for the opioid epidemic in the US.

Dentists are one part of the opioid epidemic, but the epidemic is not their fault. There are many reasons that caused the opioid epidemic and dentists are only one prescriber group. Dentists are are an important part of the solution especially since dentists are the primary prescriber of opioids to adolescents and young adults. Prescribing of opioids to adolescent and young adults has been associated with persistent opioid use. Unfortunately, prescribing resources and tools customized to oral pain have not been provided to dentists. These prescribing resources and tools to aid selection of analgesia for oral pain can help dentists to be part of the solution.

These efforts should be initiated by individual dentists and larger organizations. Professional organizations, public health and advocacy groups can use these data to inform future efforts. Adapting strategies used by other countries to minimize opioid prescribing by dentists may be a first step. In the interim, individual dentists can implement their own practice-specific guidelines (e.g, all patients without a contraindication receive ibuprofen+acetaminophen post-extraction) and only prescribe low potency opioids (e.g, acetaminophen with codeine vs oxycodone). Dentists should also check their local prescription drug monitoring program (PDMP) before they write a prescription for any opioid.

There are no disclosures. The study was funded by AHRQ.

There are some things dentists can do to decrease opioid prescribing. For example, dentists can reduce or eliminate their opioids for most dental surgeries and most patients. For example, the University of Pittsburgh School of Dental Medicine went opioid free. Dentists should also check the state prescription drug monitoring program before prescribing any controlled substance (which includes opioids). Professional organizations can develop guidelines for the treatment of oral pain. Pharmacists can provide patients with recommendations on over-the-counter pain medications. The pharmacist can also and screen for drug interactions with other medications patients are prescribed by all of their providers and OTC medications to avoid based on the patient’s medical history.

Study limitations:

• population includes commercially insured;
• age of the data;
• CDC guidelines were published in 2016

Citation:

Overprescribing of Opioids to Adults by Dentists in the U.S., 2011–2015
Suda, Katie J. et al.
American Journal of Preventive Medicine, Volume 0, Issue 0

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Last Updated on February 10, 2020 by Marie Benz MD FAAD