The opioid crisis is a significant concern in the united states of america. According to an article, more than 11 million Americans misused opioid pain relievers on prescription, and in 2016, more than 40,000 people died because of substance overdose. The opioid crisis became so severe in 2017 that President Trump declared this epidemic as a national public health emergency. Dentists prescribe approximately 12% of opioid pain medications. Around half of all opioid prescriptions prescribed by dentists and oral surgeons belong to the adolescent population who are more vulnerable to opioid abuse. Dentists often prescribe opioids after a surgical procedure or tooth extraction to alleviate pain. Because of the role dentists play in prescribing opioids, dental healthcare professionals must educate themselves about their role. They should also participate in mitigating the risks associated with opioid medicines. Continuing Education (CE) among dentists regarding opioid use becomes extremely necessary in the current scenario. Following are the five benefits of dental opioid CE in countering the opioid crisis.
- Electronic Health Records
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As part of the dental opioid CE program, electronic health records play an important role in keeping track of patients’ histories with opioid use. PDMP or Prescription Drug Monitoring Program is a state-level electronic database that collects data on prescriptions issued within a state. It provides health authorities with real-time data on patient behavior, including substance abuse if any. Dental students study how to use electronic health records and PDMP to assess and treat patients at risk for opioid misuse. They perform a patient evaluation to consider patients history during their pharmacology courses and clinical rotations. Early identification of vulnerable patients prevents further opioid prescription to them, thus preventing further drug abuse. To improve prescription of opioid, schools and clinics across the country have integrated PDMP’s into their curricula. However, standardization of PDMPs across all states is still a challenge, and there loopholes which do not track patients buying opioids across state lines.
2. Dental Institutions and Medical Colleges
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Dental institutions and medical colleges are vital in driving dental opioid CE programs all across communities. They can together increase the awareness of opioid addiction to all students in academic dental institutions. They can collaborate with other colleges or neighboring dental schools in the state. With this collaboration, they can create course curriculum/plans/modules to instill educational training to students about opioid prescription and substance abuse. Form an opioid task force within the institute as a subgroup of the school’s curriculum committee. This task force will introduce measures to revise the pedagogy of dental schools on opioid addiction. The dental schools can reassess and update the curricula related to pain management and clinical protocols. For example, encourage alternative pain management drugs like nonsteroidal anti-inflammatory drugs (NSAIDs) for the prescription. Educational bodies can collect baseline information related to prescription patterns with an emphasis on pain and anxiety control. Dentists can get hold of bespoke toolkits from these educational institutions to assist them in prescribing patients and include patient education materials on opioid addiction.
3. Healthcare Policies
Dental Opioid CE comprises of healthcare policies that augment the work of dental educational bodies to prepare future dentists. Apart from enforcing collaboration between educational institutions and encouraging the use of alternative NSAIDs instead of opioids, the health care authorities can enact legal policies to curb the misuse of opioids. Dentists should have proper education about the federal laws regarding the use of controlled substances and when to prescribe opioids. Medical malpractices include the following.
- Inadequate communication with other physicians regarding prescription or care plan
- Failure to identify the history of medication misuse in patients or prescribing drugs to patients with pre-existing substance abuse disorders
- Prescribing abnormally high dosage of opioids
Dentists can be criminally liable for prescribing an inappropriate dosage of opioids. In 2015, a dentist named Dr. Hsiu-Ying “Lisa” Teng was convicted of murder due to the overdose of analgesic opioids. Dentists should know that it is mandatory to maintain sound, ethical, and clinical judgment before prescribing opioids.
4. Pre-Procedural Counselling of Patients
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Counseling of patients is an integral part of dental opioid CE. Only half the dentists report having counseled patients on potential side effects of opioid medications. Even less number of dentists advised their patients on secure storage and disposal of unused medications. Most patients store unused opioid prescriptions in an unmonitored and unsecured location within their homes. An interview with drug users found that before catching heroin, most addicts started using opioid pain medications non-medically by accessing them through family, friends, or personal prescriptions. Dentists should counsel patients about their role in preventing the opioid crisis.
Some of the tips that they can share with their patients are the following.
- Follow the direction shown on the label of the medicine
- Awareness about potential reactions with other drugs or alcohol
- Never changing dosage regimen without discussing with your dentist
- Never use other people’s medications or share your medication with others
- Safe storage of prescription opioids and safe disposal of expired medications.
Members of the dental team can conduct the screening and provide post-prescription education to patients.
5. Referral of Individuals with Substance Abuse Disorders
Apart from reducing misuse and abuse of opioids, dentists should follow appropriate measures to screen for substance abuse disorder in patients. Screening of patients happens based on their vulnerability to opioid addiction, and dentists can refer them to alternative pain management centres. A screening tool commonly used is the Screening, Brief Intervention, Referral, and Treatment (SBIRT). It is an evidence-based practice to identify and reduce the problematic usage of opioids. Dental Opioid CE trains dental practitioners on the ways of screening, in-depth assessment, counselling, and referral of patients to pain management centres.
Conclusion:
Dentists are the forerunners in the fight against the opioid crisis. Dental Opioid CE provides dentists with the knowledge about the risks and benefits associated with opioid and the best practices for pain control within the dental practice. The above benefits of Dental Opioid CE covered measures starting from patient counselling, screening, PDMP queries, regulated opioid prescriptions, and alternative pain management. It is imperative to identify opioid-misuse susceptible patients and then treat them using alternative pain management. Using dental opioid CE, dentists can manage pain for patients in a better way and reduce the risk on the individual and society as a whole.
