The prescription drug epidemic, specifically opioid abuse, has been all over the headlines and likely on the minds of dentists and dental students across the country. Addiction treatment expert Austin Eubanks, who is also chief operating officer of The Foundry Treatment Center and a featured member of Speakers for Change, spoke at this year’s National Leadership Conference (NLC), held Nov. 17–19 in Chicago. A survivor of the Columbine High School shooting, Eubanks shared his story of how the injuries and emotional trauma he sustained drastically affected his life, leading to years of substance abuse and, ultimately, a recovery that prompted his efforts in patient advocacy. His biggest message was this: We need to transform the way we think about prescribing pain medication, specifically for patients who may be experiencing emotional pain.
“‘Pain management’ — a term that is often misinterpreted — should not be specific to physiology,” he says. “There is an enormous element of mental health when we discuss pain, so there has to be some evolution in that regard.”
Here, Eubanks discusses how dental students can be more aware of their patients’ emotional well-being to reduce the potential for addiction, as well as what they should do to ensure their own mental wellness.
During your session at NLC, you discussed how, oftentimes, the root cause of addiction is emotional pain. What can dentists do to assess what is happening in a patient’s life that may lead them to self-medication?
It can start with just having a conversation about the fact that while an opiate might be necessary for some sort of physical pain in the short-term, it can have an effect on any underlying elements of emotional pain. Find out if there has been any recent traumatic experience in that person’s life. When there’s some underlying element of emotional pain or trauma that is either undiagnosed or undisclosed, that can lead to higher likelihood of developing an addiction, specifically to opioids because of how effective they are at the short-term relief of emotional pain. If a patient is dealing with something emotionally, once the physical pain subsides, he or she may not realize that they’re now medicating that underlying emotional pain.
In Steamboat Springs, Colorado, we developed a collaborative amongst prescribers so if a person needs more than seven days of opiate medication, they’re required to have a behavioral health evaluation, so the prescriber can have a more comprehensive look into what is going on in this person’s life, talk to them and educate them about their increased susceptibility for addiction, if there is any. That education is powerful in averting that.
It can be difficult for a student or new dentist to have these conversations with patients. How do you discuss such a sensitive topic?
In a perfect world, I would recommend a representative who is equipped to have these conversations be designated to every prescriber’s office across the country — that would be the function that they performed. If the dentist is not comfortable with having those conversations, appoint somebody in the office who is. That information is valuable coming from anyone who is a [team member of that practice], whether it’s the actual prescriber or the dental hygienist, etc.
Being in a potentially high-stress environment like dental school, what can dental students do to manage their own emotional well-being?
I’ve worked with dentists in a number of capacities, and one of the things that I’ve noticed is that there’s a lot of stress that comes from the precision that is required of that position and the drive to be perfect. Also, some dentists feel that they can’t ask for help and that can lead to some pretty significant adversity in your life, personally and professionally.
[While you’re in dental school], normalize conversations around this topic and understand that it is OK to ask for help. Have a support system around you where you can have honest and transparent conversations about the things you’re struggling with, with people who hold you accountable for being a better version of yourself. Also, having a self-care plan is important. Determine what that looks like for you and then have somebody you trust fact-check that plan to make sure it is appropriate.
Is there anything students can do now to help them be more mindful of the emotional state of their patients?
Seeking education in this arena is incredibly important. Also, find ways to normalize conversations about opioid abuse and prescribing practices, not just with patients but also among peers. Once these conversations are common-place among not only dental students but practicing dentists, we’ll naturally start to evolve in the manner that we’re approaching pain management and see positive outcomes.
I had some powerful conversations with the dental students at the conference about addiction and how some of them had been affected by it in one way or another. It’s great that we’re starting to take note of these things and that the people who have the power to enact change are wanting to do so. I truly believe that the tides are turning, and I left feeling inspired by those discussions.
~Frances Moffett, ASDA Publications Manager