The American Dental Association (ADA) has entered the ring in the fight against opioid abuse. Recent mandates outlined in a new ADA policy urge dentists to limit, if not discontinue opioid prescriptions for dental pain and educate themselves on opioid abuse and the use of alternative pain medications.
The Use of Opioids for Dental Pain
Dentists with either a doctoral degree in dental surgery or dental medicine can write painkiller prescriptions to treat acute pain. Typically these dental prescriptions come in the form of narcotics like Vicodin or Percocet. Some conditions dentists have historically prescribed opioids for include:
- Tooth extractions
- Root canals
- Dental implants
- Severe tooth decay and gum surgery
- Removal of impacted teeth
Dentists were the top specialty prescribers of opioids in 1998, but have since passed that torch to medical professionals prescribing opioids for chronic pain management. The percentage of all opioids prescribed by dentists tapered from 15.5% in the late 1990’s to 6.4% by 2012 according to the ADA. Still, ADA leadership believe these numbers should be less. On the new policy to combat the opioid epidemic, ADA Spokesperson Paul Moore, DMD, MS, PhD, MPH said: “As dentists, patients are our first priority. We have long been committed to multidisciplinary efforts to end the opioid epidemic, and this is a great step that the dental community is embracing to help combat the epidemic.”
Trends in Opioid Dental Prescriptions
Recent research published in the Journal of the American Dental Association serves as ammunition for immediate change in the way opioids are prescribed for dental pain:
Opioid alternatives are more effective.
A systematic review of pain management data found that a dosage of 1000 mg acetaminophen and 400 mg ibuprofen worked better for acute pain relief in adults and had less adverse effects than painkillers that contained opioids. Dr. Moore says they’re still learning more and evaluating the opioid-free drug combination to determine the most effective doses and proper dosing strategies for procedures. “This approach could maximize patient comfort, while limiting the need to use opioids analgesics such as Vicodin for treating acute postoperative dental pain,” he said.
Gender and racial differences in opioid prescriptions.
A review of 890,000 Medicaid claims between 2013 and 2015 revealed dentists were 50% more likely to prescribe opioids for dental pain to women and twice as likely to prescribe them to African Americans and non-Hispanic Caucasians. The same study found people seen in ER departments for dental pain were almost five times more likely to obtain an opioid dental prescription than if treated in a dentist’s office.
Opioid dental prescriptions have increased in some age groups.
According to data from prescription databases, among healthcare providers, dentists most frequently prescribe opioids to teenagers. Dentists saw the greatest spike in opioid prescriptions for 11 to 18 year olds from 2010 to 2015 — an increase of 100 to 165 prescriptions per 1,000 teens. Overall, opioid prescriptions for dental pain jumped from 131 to 147 per 1,000 people.
This last study is particularly concerning given that research shows teens are 33% more likely to develop an opioid addiction when exposed to opioids, even if legally prescribed. Dr. Moore told the Associated Press: “The fact that we’re still prescribing opioids when we’ve demonstrated that nonsteroidals are as effective most of the time is a little disturbing. [For many teens] this is going to be their first experience with opioids. Maybe it is our opportunity to stop and counsel patients about the dangers.”
New Policy for Dentists Prescribing Painkillers
To this point, the ADA released a new policy for dental prescriptions and practices on March 26, 2018. The policy has been called one of the first of its kind among healthcare professional organizations and follows on the heels of the American Medical Association’s (AMA) Opioid Task Force. The new policy supports:
Dentists are encouraged to confine the dosage and quantity of opioid dental prescriptions to seven days or less for acute pain treatment.
Painkiller abuse education
The policy calls for mandatory addiction education on prescribing opioids and other controlled substances for dental pain. Dr. Moore says the ADA will offer courses at meetings, including “Safe and Responsible Prescribing of Opioid Analgesics” at ADA 2018 this October as well as host four opioids-related webinars this year.
Registration and use of Prescription Drug Monitoring Programs (PDMPs)
These databases track prescriptions for controlled substances. Moore says these efforts will promote the appropriate use of opioids and deter misuse and abuse. “I’m pleased to see dentistry working to fully implement PDMPs,” he said. “Knowing what our patients are taking can only improve safety.”
The ADA’s new policy is a good start, but doesn’t translate into the law of the land yet. Dentists and lawmakers can choose whether or not to adopt these mandates. Encouragingly, many states have done so. Some are also putting into practice other restrictions around opioid dental prescriptions such as written consent from parents for patients under the age of 18. “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,” said ADA President Joseph P. Crowley, D.D.S. in an ADA press release. “This new policy demonstrates ADA’s firm commitment to help fight the country’s opioid epidemic while continuing to help patients manage dental pain.” Time will tell if ADA’s new policy helps reduce opioid dental prescriptions and makes a dent in a public health crisis that claims hundreds of lives daily. Researchers and addiction experts will surely be watching the numbers in the years to come.