There is no shortage of news, facts or statistics on the opioid epidemic. As a dental student, you’ve probably been inundated with this information. ASDA’s Council on Advocacy wants to help you make sense of the crisis and the ways you can advocate for your patients.
The council held an expert panel to assess the epidemic through the dental profession lens. Perspectives on organized dentistry, interprofessional efforts and legislative actions were discussed to help students understand the issue. Here are the key takeaways you should know as you begin to combat the opioid epidemic.
The role of dentistry
The U.S. Department of Health and Human Services reports that opioid overdoses contributed to more than 42,000 deaths in 2016. Many of these overdoses involved prescribed drugs. Dentists aren’t the No. 1 prescriber of opioids in the United States, but according to Drs. Sharon Parsons, vice president of the Ohio Dental Association, and David Anderson, director of oral and maxillofacial surgery at Roseman University of Health Sciences College of Dental Medicine, dentists have been part of the problem.
First-time exposure to opioids oftentimes happens after wisdom tooth removal. This places young patients at risk because they are more likely to become addicted when exposed to opioids, as their prefrontal cortex is still forming. Dr. Parsons implored dental students to internalize this fact and to consider alternatives to opioids such as ibuprofen and acetaminophen for acute pain management.
In addition to opioid alternatives, profession-wide measures such as mandatory continuing education and prescribing limits are necessary to stymie the epidemic. Dr. Parsons shared that in October 2018, the ADA House of Delegates formally adopted an interim policy advocating for these changes. This made the ADA one of the first professional health organizations to develop this kind of policy.
The American Association of Oral and Maxillofacial Surgeons (AAOMS) has also taken a stand against opioids. Dr. Anderson highlighted white papers the organization created on prescription drug abuse and prevention. In addition to CE and prescribing limits, the specialty organization recommends prescription drug monitoring programs. These programs require dentists to check a patient database to ensure the patient hasn’t recently received a prescription from another health care provider.
Organizational policy statements and white papers have created evidence-based measures to address the issue. Legislation at the state and federal levels also is needed to bolster prevention efforts and to provide aid to patients already suffering from addiction.
Dr. Richard D’Innocenzo, clinical professor and director of pre-doctoral education in the Department of Oral & Maxillofacial Surgery at Boston University Henry M. Goldman School of Dental Medicine, highlighted state-level measures to prevent prescription misuse. Massachusetts passed legislation in 2016 creating a prescription monitoring program and setting limits on initial opioid prescriptions for adults and minors. Addiction education also became a requirement for parents of minors receiving opioids. The CARE Act of 2018 enhanced these measures by requiring all prescribers to use secure electronic prescriptions for controlled substances and creating a commission to create recommendations on appropriate prescribing practices in dentistry.
Measures to reduce the number of opioids available to patients, create prescribing standards and promote patient education are being discussed at the federal level. In 2018 alone, more than 140 pieces of opioid legislation were considered by Congress. The Support for Patients and Communities Act was adopted in October. Due, in part, to the efforts of the 2018 ADA Dentist and Student Lobby Day, principles supported by the dental profession were included in the bill. These included funding for research into the best pain management practices with minimal opioid use and resources for states to enhance prescription drug monitoring programs.
State and federal legislation on opioid prescribing will continue to be discussed and enacted. As a dental professional who may prescribe opioids, you need to know about opioid addiction, to practice responsibly and to advocate for initiatives that combat the issue. Dedicate one hour of your day to watch the panel to advance your understanding of the issue.