Dentists Can Help Fight Painkiller Addiction
Addiction to prescription painkillers is a growing problem in the United States and researchers are calling on dentists to help staunch the flow of opioid medications.
The National Survey on Drug Use and Health says that seven of every 10 abusers of prescription drugs obtained their medications from a family member or a friend who had a legitimate prescription. Two-thirds of those who take opioids for nonmedical reasons obtained them from the family’s medicine cabinet.
A Significant Role
Dentists hand out 12% of the prescriptions written for non-timed release opioids – the second largest set of prescribers in the country behind general practitioners. Changing dental prescribing practices could be one way to address the issue.
Dentists are taught in dental school how many painkillers to prescribe following difficult or painful procedures. Perhaps, researchers suggest, it is time to reconsider those time-cherished and inculcated guidelines.
At school, dentists are instructed to prescribe 20 pills following invasive procedures. A research team led by Brown University psychiatry professor George Kenna thinks that dentists should reconsider that strategy. If most abusers are accessing "leftover" medications in the family medicine chest, Kenna posits the notion that smaller prescriptions could reduce the readily available "stash."
Recommendations for Dental Prescriptions
Kenna led a team of dentists, pharmacists and addiction experts in writing the cover article for the most recent edition of The Journal of the American Dental Association (JADA). The article focused on the role dentists play in prescription painkiller availability and what dentists can do to reduce the likelihood that dental prescriptions will be misused. The JADA article outlined several recommendations:
- Talk with patients about whether or not they require opioids and the likelihood that they will use the full prescription.
- Write smaller prescriptions initially with limits on future refills.
- Avoid writing prescriptions for new patients or those about whom little is known.
- When possible, access monitoring programs that can check a patient’s drug history.
- Discuss with patients the importance of locking up or destroying unused medications.
- Lock up/secure prescription pads.
After modifying prescription practices, patient education can be part of a dentist’s strategy toward reducing "leftover" painkillers. Many households keep cabinets loaded with surplus painkillers like oxycodone and hydrocodone out of fear of future pain. The researchers recommend that dentists make plain to their patients the potential dangers of unsecured painkillers in the home. If patients are willing to part with their unused medications, the dentist can apprise them of DEA-sponsored drug "take back" days in lieu of flushing them (which could affect the water supply). Finally, dentists can point patients to data which suggest ibuprofen is as effective as addictive painkillers in managing pain associated with inflammation.
Not only can dentists adopt new prescribing parameters and engage in patient education, but they can add two components to patient care that might positively impact the control of opioids:
- As uncomfortable as it may be, dentists can add questions about substance abuse to the health histories taken from incoming patients.
- Dentists can work to improve the coordination of care with oral surgeons in order to better monitor patient prescriptions.