In a “dear colleague” letter to dental professionals last month, American Dental Association President Carol Gomez Summerhays urged dentists to review their prescribing practices and more effectively counsel patients about the safe handling and use of medications, especially opioid painkillers.
Summerhays also urged dentists to consult databases maintained by state-run prescription drug monitoring programs that could help them identify “doctor-shopping patients” whose prescription histories may reveal drug-seeking behavior. She wrote:
Patients have a responsibility to use opioid painkillers only as prescribed and to keep their unused medications from getting into the wrong hands. We can empower them by being more judicious in our prescribing when less aggressive treatments are indicated. We can also make sure patients leave our offices knowing about their abuse potential and how to safely secure, monitor and discard them at home.
In 2014 alone, drug overdoses claimed over 47,000 lives and 40 percent of those deaths involved opioid analgesics, Summerhays noted, citing figures from the Centers for Disease Control and Prevention. Opioid addiction and dependency affect an estimated 2 million Americans.
President Obama in July passed a bill aimed at combating opioid abuse, as fellow core topic leader Liz Seegert noted in a blog post last week. In addition, several states have enacted legislation in response to the crisis, according to the National Academy of State Health Policy.
But more study is needed to ensure the effectiveness of these new laws, according to Summerhays. Research on dental prescribing practices “is still scant, leaving lawmakers to make far-reaching policy decisions based on anecdotal evidence and haphazard assumptions,” she wrote.
Dentists are among the leading prescribers of opioid pain medications, according to numerous studies. Prescriptions often are written for patients who have undergone surgical tooth extractions, noted a research letter, published in April by the Journal of the American Medical Association (JAMA). The authors, a research team from Boston’s Brigham and Women’s Hospital and Harvard Medical School, raised questions about the common practice of treating post-extraction pain with opioids.
Of the more than 79 million prescriptions written for opioid analgesics in 2009, dentists were the third most frequent prescribers, according to a another study published in JAMA.
“Overall, the main prescribers were primary care physicians (general practitioner/family medicine/osteopathic physicians) with 28.8 percent (or 22.9 million) of total prescriptions, followed by internists at 14.6 percent (11.6 million), dentists at 8 percent (6.4 million), and orthopedic surgeons at 7.7 percent (6.1 million),” the authors said.
But a federal report called the National Prescription Audit reflected somewhat different findings for a more recent year. It concluded that dentists were the fifth most frequent prescribers in 2012, after family practitioners, internists, general practitioners and surgeons.
Summerhays found reason to applaud the findings as a sign of progress. In 2003, dentists were the second most frequent prescribers of opiod pain medications, she noted.
In a July 4 opinion piece in the Pittsburgh Post-Gazette, Patricia Raygada-Rabanal a master of public health candidate in the Department of Health Policy and Management at the University of Pittsburgh Graduate School of Public Health, appealed for more cooperation between dentists and other health care professionals in helping patients to cope with pain.
“Integration of dental and medical information would greatly improve dental pain treatment and management. Team-based care and greater collaboration between these two sectors of health care would provide a clearer understanding on how to treat pain without jeopardizing the patient’s overall quality of life,” Raygada-Rabanal wrote.
