Arizona has been working diligently over the last few years to combat the opioid epidemic taking our nation by storm. We have made significant progress through legislative action and executive order as well as by working collectively as a state to implement policies aimed at preventing and treating opioid addiction and overdoses.
Governor Doug Ducey recently pointed out that between June 2017 and June 2018, the number of opioid prescriptions in the state dropped by 40%, the number of pills dispensed to patients decreased by 43%, and the number of people being referred to drug treatment increased by nearly 30%. And although this is indeed significant measurable progress, we still have a long way to go. State numbers recently released revealed that opioid related deaths are still on the rise, claiming the lives of nearly three Arizonans every day, and numbers are very similar around the country.
For many, exposure to opioids is tied to pain management from an injury, surgery, or, in the case of my expertise, oral surgery. Dental professionals are sometimes overlooked as responsible parties for prescribing opioids, but our role in curbing this epidemic is a responsibility we don’t take lightly.
Dental professionals are embracing the use of nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen. Studies show that NSAIDs, particularly NSAIDs in combination with acetaminophen like Tylenol, are more effective than opioids in relieving postoperative dental pain with fewer side effects and less potential for abuse. If opioids are necessary for the occasional patient, we are careful to prescribe the lowest possible effective dosage for as short a period as possible.
The collective dental community continues to show commitment to preventing opioid misuse. Earlier this year, the ADA released an interim policy that supports mandatory continuing education for dentists on prescribing opioids. The policy also encourages dentists to take advantage of state prescription drug monitoring programs, which can help inform prescribing decisions and curb the misuse of prescription opioids.
In Arizona, participation by dentists in the Arizona Board of Pharmacy Controlled Substances Prescription Drug Monitoring Program (PDMP) is mandatory, including a requirement that a patient’s PDMP record be checked online before prescribing a controlled substance. This gives us a crystal-clear picture of the patient’s opioid prescription history from all providers, not just dentists.
One aspect of the Arizona Opioid Epidemic Act signed by Ducey earlier this year is the mandate for all prescriptions for Schedule II controlled substances, which include Demerol, Fentanyl, OxyContin, and Vicodin, to be transmitted to pharmacies electronically. This requirement for Electronic Prescriptions for Controlled Substances (EPCS) will dramatically reduce counterfeit prescriptions, thereby making Arizona safer. Arizona is way ahead of the curve on this issue, becoming only the second state after New York to mandate EPCS.
Even though EPCS does improve safety by reducing the number of counterfeit prescriptions that will be filled, it does not protect society from the few “bad players” in the healthcare industry. In October, five “New York doctors” were indicted for prescribing 8.5 million opioid pills. The US Attorney on the case described them as “drug dealers in white coats.”
Fortunately, one aspect of the SUPPORT for Patients and Communities Act (HR 6), which was passed with bipartisan support in the US House and Senate and now and awaits President Trump’s signature, is to identify outlier prescribers of opioids.
In this battle against opioid misuse, I am pleased to be in a leadership role with a company like Delta Dental. As the nation’s largest dental insurer, Delta Dental maximizes its unique role of having 75% of the nation’s dentists in its provider network to be an actively engaged voice and partner in the fight against opioid misuse.
Delta Dental is driving research, funding, and education to eradicate the scourge of opioid abuse and addiction here in Arizona and throughout the nation. These initiatives include facilitating safe opioid disposal; offering opioid-focused continuing education credits to the dentist, hygienist, and oral care worker community; and sponsoring prevention and treatment activities.
We have made positive strides to combat opioid misuse over the last year, but this is an unparalleled epidemic—and a national health emergency—that demands our constant attention. I encourage physicians, dentists, and all other professionals who have the ability to prescribe medications to continue looking for and implementing solutions to fight against opioid misuse. The battle is far from over.
Dr. Harvey is the Delta Dental of Arizona board chair and a practicing periodontist in Tucson. He holds a DDS as well as a master of science degree and certificate in periodontics from the University of Iowa. He also has held numerous leadership positions in the Arizona Dental Association, serving as president in 2001 and as editor of its journal from 2004 to 2008. And, he is involved with the Arizona Dental Foundation, serving as a board member from 1988 to 2011. He can be reached at firstname.lastname@example.org.
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