Prescription opioids continue to contribute to the opioid overdose epidemic in the United States. In fact, more than 40 percent of all U.S. opioid overdose deaths in 2016 involved a prescription opioid.1
To keep health care professionals up to date on this issue, government agencies including the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health as well as health professional societies provide a wide variety of information and resources. Dentists can consult the American Dental Association for continuing education, its policy on opioid prescribing (see below), and the April 2018 edition of the Journal of the American Dental Association that focuses on opioids and dentistry.
- Consider nonsteroidal anti-inflammatory analgesics as the first-line therapy for acute pain management.2
- Consider using multimodal opioid-sparing strategies such as pre-treatment with NSAIDS and long-acting local anesthesia.
- If you consider prescribing an opioid for acute pain, follow the CDC guidelines3:
- Prescribe the lowest effective dose of immediate-release opioids.
- Prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids.
- Note that three days or less will often be sufficient, and more than seven days will rarely be needed.
- Be aware: You may be the first to prescribe an opioid to an adolescent if you write a prescription after third molar extraction. It’s also important to know research has shown that medical use of prescription opioids is highly correlated with non-medical use of prescription opioids among high school seniors. Among adolescents who reported both types of use, medical use generally came first.4 In view of this risk, consider non-opioid analgesics for this population instead.
- Register with and use your state’s Prescription Drug Monitoring Program (PDMP) to promote the appropriate use of opioids and deter misuse and abuse. When opioid prescribing is indicated, risk of misuse and diversion may be mitigated by consistent PDMP use and patient education.5
- Counsel your patients if you prescribe an opioid pain medication:
- Ask about any other medications they’re currently taking, and whether they or any family members have had problems with substance abuse, such as with alcohol, prescription medications, or illicit drugs.
- Explain the risks of taking the medication.
- Describe how to take the medicine and how long to take it.
- Explain that alcohol should never be used when taking an opioid medication.
- Provide guidance on storing medication in a safe place out of sight and out of reach of children, preferably in a locked cabinet.
- Visit the American Dental Association web page on prescription opioid abuse. The ADA’s current policy:
- Supports mandatory continuing education in prescribing opioids and other controlled substances.
- Supports statutory limits on opioid dosage and duration of no more than seven days for the treatment of acute pain, consistent with the Centers for Disease Control and Prevention evidence-based guidelines.
- Supports dentists registering with and utilizing Prescription Drug Monitoring Programs to promote the appropriate use of opioids and deter misuse and abuse.
- Know your state’s regulations. To address the opioid overdose epidemic, many states recently have enacted laws that set time or dosage limits on the prescribing or dispensing of controlled substances. Check with your state dental association or state dental board for details.
Below are additional resources about the opioid crisis. (Information for your patients can be found on the NIDCR Opioids webpage for consumers.)
- Dentists Play Vital Role in Addressing Opioid Crisis
Commentary by NIDCR Director Martha Somerman, DDS, PhD, and National Institute on Drug Abuse Director Nora Volkow, MD, in the Journal of the American Dental Association. Describes the role of the oral health community in addressing the opioid overdose epidemic and NIH-funded research and initiatives that aim to inform clinical decision making related to opioid prescribing.
- NIDCR Clinical Research Fellowship Grand Rounds, March 17, 2017
A talk titled “America’s Opioid Overdose Epidemic: What We Know and How Health Practitioners Can Help,” presented by Debra Houry, MD, MPH, from the Centers for Disease Control and Prevention.
Resources for health professionals on the causes and consequences of drug use and addiction, and advances in pain management.
- American Dental Association. Prescription Opioid Abuse
Resources for dentists on the opioid abuse problem, including ADA policies and statements and a link to continuing education.
- The Role of Dental Education in the Prevention of Opioid Prescription Drug Misuse
A policy paper from the American Dental Education Association, Office of Policy, Research and Diversity; 2018.
- NIH Helping to End Addiction Long-term (HEAL) Initiative
Trans-agency effort to speed scientific solutions to stem the national opioid public health crisis.
- NIH Pain Consortium
A consortium that enhances pain research and promotes collaboration among researchers across the many NIH Institutes and Centers that have programs addressing pain.
- The NIH Pain Consortium Centers of Excellence in Pain Education (CoEPEs) focus on the development, evaluation, and distribution of pain management curriculum resources.
- Centers for Disease Control and Prevention (CDC). Opioid Overdose: Information for Providers
Information for health professionals, including prescribing information for chronic pain. Until the CDC publishes guidelines for prescribing opioids for acute pain, the ADA recommends dentists review and follow the relevant sections of the existing guidelines.
- U.S. Food and Drug Administration (FDA). Safe Disposal of Medicines
A webpage with information such as where and how to dispose of unused medicines.
A website from the U.S. Department of Health and Human Services that provides information about the national opioid crisis as well as help and resources.
- Centers for Disease Control and Prevention. (2017). Prescription opioid data. Retrieved from https://www.cdc.gov/drugoverdose/data/prescribing.html
- American Dental Association. (2016). Statement on the use of opioids in the treatment of dental pain. Retrieved from https://www.ada.org/en/advocacy/current-policies/substance-use-disorders
- Dowell, D., Haegerich, T. M., & Chou, R. (2016). CDC guideline for prescribing opioids for chronic pain — United States, 2016. MMWR. Recommendations and reports, 65(No. RR-1), 1-49. http://dx.doi.org/10.15585/mmwr.rr6501e1
- McCabe, S. E., West, B. T., Veliz, P., McCabe, V. V., Stoddard, S. A., & Boyd, C. J. (2017). Trends in medical and nonmedical use of prescription opioids among US adolescents: 1976–2015. Pediatrics, 139(4), pii: e20162387. doi:10.1542/peds.2016-2387
- McCauley, J. L., Leite, R. S., Gordan, V. V., Fillingim, R. B., Gilbert, G. H., Meyerowitz, C., … National Dental Practice-Based Research Network Collaborative Group. (2018). Opioid prescribing and risk mitigation implementation in the management of acute pain: Results from The National Dental Practice-Based Research Network. Journal of the American Dental Association, 149(5), 353-362. https://doi.org/10.1016/j.adaj.2017.11.031