By Mary Otto
President Donald Trump’s Commission on Combating Drug Addiction and the Opioid Crisis is not alone in calling upon the nation’s dentists to help limit the flow of addictive painkillers to the American public.
In 2016, Vivek Murthy, U.S. surgeon general under President Barack Obama, launched a campaign to combat drug addiction that included an appeal to health care professionals – including dentists – to consider alternatives when helping patients manage pain.
“We want people to reach for non-opioids whenever possible,” Murthy stressed.
Opioid addiction often begins with a routine prescription for pain medication, Murthy and many experts have observed. Dentists remain among the top prescribers of opioid analgesics, concluded a 2016 research letter published in the Journal of the American Medical Association (JAMA).
Surveys suggest that dentists regularly prescribe opioids to treat post-extraction pain “despite evidence that a combination of nonsteroidal medications and acetaminophen may provide more effective analgesia for post-extraction pain,” the authors wrote. They cited a 2013 study which found that ibuprofen and acetaminophen pain medicines to be safer alternatives to opioids for acute pain management after wisdom tooth (third molar) extractions.
Several studies over the years have identified dentists as leading prescribers of opioids. Of the more than 79 million prescriptions written for opioid analgesics in 2009, dentists were the third most frequent prescribers, according to a major analysis of national pharmacy data published in the Journal of the American Medical Association (JAMA) in 2011.
“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, the authors concluded. That was 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),” However, for patients age 10 to 19 years, dentists were the main prescribers, the researchers found.
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.
In a 2016 “dear colleague” letter to dental professionals, then-American Dental Association President Carol Gomez Summerhays urged dentists to review 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, which could help them identify “doctor-shopping patients” whose prescription histories might reveal drug-seeking behavior.
As awareness has grown about the risks of addiction, some in the dental profession have reassessed their prescribing habits.
State dental boards have issued new guidelines for patients and practitioners to stem the flow of addictive drugs, according to Philadelphia radio journalist Elana Gordon in a piece that aired earlier this year on National Public Radio’s Weekend Edition Sunday.
Gordon’s report included the memorable story of a dental-patient-turned-addict named James Hatzell who recalled that an important moment in his struggle with drugs came when he was a high school junior. His wisdom teeth were removed and his dentist prescribed a narcotic for the pain.
Hatzell, now 23, has been in recovery for three years. He told Gordon he never wants to go down the road into drug dependency again.
In an Aug. 11 statement, the ADA commended President Trump’s decision to declare opioid abuse as a national emergency.
“The president’s statement will encourage the Department of Health and Human Services to bolster education efforts aimed at health care providers and students at dental and medical schools,” the organization said.
But the group also noted that in the coming days it would be asking the White House Commission on Combating Drug Addiction and the Opioid Crisis consider “the nuances of managing short-term acute pain versus long-term chronic pain” and to “avoid duplicating or undermining what states have been doing on this issue for years.”
In a March white paper, the American Association of Oral and Maxillofacial Surgeons also acknowledged the epidemic nature of opioid addiction in America and emphasized the need for provider judgment in prescribing painkillers.
