The ADA has announced a new policy on opioids supporting mandates on prescription limits and continuing education in what could be the first of its kind among major healthcare professional organizations. It states:
- The ADA supports mandatory continuing education in prescribing opioids and other controlled substances.
- The ADA 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.
- The ADA supports dentists registering with and utilizing prescription drug monitoring programs to promote the appropriate use of opioids and deter misuse and abuse.
“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, DDS. “This new policy demonstrates ADA’s firm commitment to help fight the country’s opioid epidemic while continuing to help patients manage dental pain.”
Most opioids prescribed to patients in the United States are written by physicians and other medical professionals for management of chronic pain, the ADA reports. Dentists with an appropriate license also may prescribe opioids, most often for management of acute pain such as severe tooth decay, tooth extraction, and root canals.
In 1998, according to the ADA, dentists were the top specialty prescribers of opioid pain relievers, accounting for 15.5% of all opioid prescriptions in the United States. By 2012, this number had fallen to 6.4%. The April issue of The Journal of the American Dental Association (JADA) features additional information about opioid prescriptions, including:
- An examination of five systematic reviews concluded that acetaminophen and non-steroidal anti-inflammatory drugs such as ibuprofen are equal or superior to opioids for dental pain, supporting the ADA’s 2016 policy statement that dentists consider them as the first-line therapy for acute pain management.
- A review of opioid prescription claims from about 1.1 million privately insured dental patients from 2010 to 2015 indicated that patients who received an opioid prescription from a dentist were given a median supply to last three days. Also, across all age groups, opioid prescriptions increased by 17 per 1,000 patients, with the largest increase among patients aged 11 to 18, and those in the 11 to 18 and 19 to 25 age groups receiving a higher median dose than other age groups.
- A review of the claims of more than 890,000 Medicaid patients from 13 states between 2013 and 2015 indicated that emergency department prescribed opioid medications almost five times more often than dentists and nurse practitioners prescribed them nearly three times as often as dentists. Also, women were 50% more likely than men to receive an opioid prescription for pain management of a dental condition. Whites and African-Americans were about twice as likely to receive an opioid prescription as Hispanics.
- Authors from the Harvard School of Dental Medicine and Tufts University of Dental Medicine and a retired lieutenant from the Massachusetts State Police provided 10 clinical scenarios that dental prescribers might encounter and how they can assess prescription monitoring program data from a clinical, risk assessment, and law enforcement perspective.
“The JADA articles shine an important light on a public health epidemic from the dental perspective and signal that while the percentage of opioids prescribed by dentists has decreased since 1998, we can continue to do even more to help keep opioids from being a source of harm,” said Crowley. “Working together with physicians, pharmacies, other healthcare professionals, and the public, we believe it is possible to end this tragic and preventable public health crisis that has been devastating our families and communities.”