By Genni Burkhart
According to recent figures released by the National Center for Health Statistics, 100,000 Americans died of drug overdoses during a 12-month period through April of this year. Federal researchers report that overdose deaths were up nearly 30 percent from the 78,000 deaths recorded last year. This increase was due to reduced access to treatment, rising mental health issues, and readily available deadly street drugs–all influenced by the simultaneous spread of COVID-19. This news comes as we better understand the role prescription opioid analgesics play in addiction, as they're responsible for most overdose deaths in America.
Opioid analgesics also happen to be among the most commonly prescribed drugs by dentists. Researchers are looking at this correlation and bringing dentists into the conversation. We'll look at some of the recent studies on the issue and how science is looking to provide dentists with the tools needed in helping to battle the opioid epidemic in America.
De-implementing Opioid Prescriptions
According to a study published on JIMR, around five million people undergo third-molar extractions in the United States each year, resulting in the need for postoperative pain management. Researchers in this study are looking at ways to increase the use of ibuprofen and acetaminophen as a preferred alternative to opioid analgesics in managing (most) postextraction pain, thereby decreasing the need for opioid prescriptions.
This study was conducted with clinical decision support education (CDS-E) and without patient education (CDS) under protocols approved by the National Institute of Dental and Craniofacial Research (NIDCR). There were 51 dental providers involved and randomized to CDS, CDS-E, or standard practice where opioid analgesics were prescribed. The outcome of the study will be determined by a thorough review of the patient's electronic health records. If the intervention strategies are proven effective, the objective is to implement them on a wider scope within dental settings that have a high amount of opioid prescriptions.
Children and Young Adults at High Risk
Children and young adults are often prescribed opioid analgesics after surgery to manage pain.
A study in the September 2021 AAP Pediatrics found that many of the prescribers are dentists or surgeons who disproportionately practice in the South. The study also discovered that a relatively small number of prescribers in the top five percent account for half of all opioids prescribed to children and young adults, and account for half of "high-risk prescriptions."
The University of Michigan, MHealth Lab released an article in August of this year on this study. The lead author of the study, Kao-Ping Chua, M.D., Ph.D., a pediatrician and researcher at the University of Michigan Health C.S. Mott Children's Hospital and the Susan B. Meister Child Health Evaluation and Research Center states, "Our study suggests that children and young adults are frequently exposed to unsafe opioid prescriptions, increasing their risk of overdose, misuse, and addiction." She goes on to state that, "The fact that these prescriptions were so heavily concentrated among a small group of prescribers suggests that quality improvement efforts should target these prescribers."
Dr. Kao-Ping Chua goes on to recommend that shorter prescriptions schedules can be used post-surgery, and points to the fact that recommended prescription guidelines should become widespread standard practice.
The ADA Looks at Education Strategies
A 2018 study in the Journal of the American Dental Association (JADA) looked at the benefits of using risk mitigation strategies for dentists when prescribing opioids. This included risk screening, prescription drug monitoring programs (PDMP), and patient education. This research was conducted by using a web-based survey among practicing dentists in the National Dental Practice-Based Research Network.
Of the 822 dentists who completed the survey, the number of dentists that reported prescribing opioids alone was 11 percent, and those prescribing a combination nonsteroidal anti-inflammatory drugs or acetaminophen was 18 percent, with one half or more of their patients needing management of acute pain. It's important to note that the study discovered higher levels of opioid prescriptions associated with lower implementation of prescription drug monitoring programs.
Similar to the study published in JIMR, this study looked at the role patient education and clinical support plays in reducing the misuse of opioid analgesic prescriptions. It was the conclusion of this study that more dental education is needed if patient risk is to be lowered.
As 2021 draws to a close, the record number of overdose deaths just released by the CDC is a glaring reminder that this pandemic will have far-reaching and lasting effects on the wellbeing of our nation for years to come. As dentists are drawn further into the conversation of what can be done, it's important to note that being part of this conversation involves the whole health of patients, mental and physical. As dental professionals are themselves under increased pressure and demands, the ability to promote healthy patient behavior in regard to opioid analgesic prescriptions will further the vitality of a practice going forward, and support the complete health of patients long after they leave the dental operatory. Patient pain must be properly managed, but in ways that lower the risk of abuse.
Rindal DB, Asche SE, Gryczynski J, Kane SM, Truitt AR, Shea TL, Ziegenfuss JY, Schwartz RP, Worley DC, Mitchell SG, De-Implementing Opioid Use and Implementing Optimal Pain Management Following Dental Extractions (DIODE): Protocol for a Cluster Randomized Trial, JMIR Res Protoc 2021;10(4):e24342
doi: 10.2196/24342 PMID: 33843594 PMCID: 8076983
Kao-Ping Chua, MD, PhD; Chad M. Brummett, MD; Rena M. Conti, PhD; Amy S. Bohnert, PhD. Opioid Prescribing to US Children and Young Adults in 2019, Pediatrics (2021) 148 (3): e2021051539. https://doi.org/10.1542/peds.2021-051539
Jenna L. McCauley, PhD, Renata S. Leite, DDS, MS, Valeria V. Gordan, DDS, MS, Roger B. Fillingim, PhD, Gregg H. Gilbert, DDS, MBA, Cyril Meyerowitz, DDS, MS, David Cochran, DDS, MS, PhD, MMSci, D. Brad Rindal, DDS, Kathleen T. Brady, MD, PhD, The National Dental Practice-Based Research Network Collaborative Group, ORIGINAL CONTRIBUTIONS OPIOIDS| VOLUME 149, ISSUE 5, P353-362, MAY 01, 2018, Opioid prescribing and risk mitigation implementation in the management of acute pain. Published: March 14, 2018 DOI: https://doi.org/10.1016/j.adaj.2017.11.031
Author: With over 11 years as a published journalist, editor, and writer Genni Burkhart's career has spanned across politics, healthcare, law, business finance, and news. She resides on the western shores of the Puget Sound where she works as the Editor in Chief at DOCS Education out of Seattle, WA.