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Dentist Dealers: Opioid Addiction Bites Back After Over-Prescription

Last week, NBCNightly News featured opioid addiction in “Hooked: Fighting America’s Addiction to Painkillers,” a collection of news stories that aims to shed new light on the opioid epidemic spreading in the United States. While Americans have been fighting a serious prescription painkiller addiction for the past two decades, along with heroin and other opiates, national awareness on the subject remains an urgent matter as new drugs get approved by the FDA and more opportunities to become addicted slip into the daily routine.

One story of the series in particular—“The Deadly Triangle: Dentists, Drugs and Dependence”—may open some eyes for folks, with NBC revealing the dangerous connection between opioid addiction and over-prescribed medications from dentists. It seems like your friendly “Dr. Smiles” dentist from the neighborhood may just be your unsuspecting gateway to a life of opioid abuse.

But has it always been this way? Surely, dentists haven’t banded together as some underlying evil force with a mission to lure Americans toward a crippling opioid addiction one toothache at a time. How is it that the heroin and prescription painkiller epidemic plaguing the country has root ties to the dental chair? And is there a way to fix it?

Dentists Are Over-Prescribing Opioid Painkillers to Patients

Now, NBC isn’t the first to point out the correlation between dentists and opioid painkiller addiction. Studies back in 2011 were published in the Journal of the American Medical Association (JAMA), which detailed that dentists wrote the third-most prescriptions for opioids in the United States, especially after performing surgical tooth extractions on their patients.

Even the Obama administration aimed to put focus on the prescription painkiller epidemic in April of 2011, just after the Office of National Drug Control Policy had released a national action plan, including drug and overdose prevention strategies.

Still, come 2012, the Journal of the American Dental Association (JADA) would publish a survey that suggested dentists continued to over-prescribe their patients, particularly within the age range of 10 to 19 years old—right at the time most people get their wisdom teeth removed. It was noted that US dentists “write between 200 million and 300 million antibiotic prescriptions each year,” which would account for nearly 10 percent of all such prescriptions given out in the United States.

Considering there are only 323.8 million people in the United States in total, just how many prescriptions were people getting?

Opioid Addiction Awareness Necessary, Many Unaware of Consequences

“The reason a lot of people go to the dentist is because they have pain, or they undergo a procedure that causes some pain, for which the dentists are responding,” said Brian Bateman, an associate professor at Harvard Medical School who co-authored a 2016 study that further recorded dentists’ over-prescription of opioid tablets in the United States.

In an article by Pain Medicine News, Bateman told them, “But I believe we have gotten away from thinking about opioids as dangerous medications. Dentists may not be as conservative as they need to be with respect to using these medications, and reserving them only for patients with truly severe pain for which other treatment approaches are not adequate.”

It turns out that according to the JADA survey, dentists get a little “shy” about bringing up substance abuse with patients, even though, in their industry, it’s a prevalent issue that patients may be using them as a means to obtain drugs. Of the dentists surveyed, 1 in 3 admitted they did not routinely ask new patients about substance abuse, nor did the dentists educate their patients about prescription opioid painkillers and how they can lead to misuse and addiction.

In fact, plenty of alternative, non-addictive painkillers exist for patients to use after dental work, such as Aleve or acetaminophen, but not all dentists keep up with the effectiveness of regular, over-the-counter painkillers or bring them up as an alternative to their patients. While certain patients with stomach problems or liver disease may have to seek prescription medicines, most people will do just fine with a couple of Tylenol pills.

“The first thing a dentist needs to do is understand the patient,” advised Noshir Mehta, professor and chair of general dentistry at Tufts University, who also worked with his colleagues to present their findings in the Journal of the American Dental Association. In an article by Tufts Now, Mehta pointed out, “Many dentists don’t understand the ramifications, both short- and long-term, of these opioids.”

Other dentists, as first pointed out in the JAMA study in 2011, still struggle with handling substance abuse as a topic with their patients. A certain level of “patient expectation” occurs when patients anticipate more pain from their dental work than what actually occurs, which then fuels their demand for more opioid painkillers from their dentists. Without having any proper training on how to deal with this scenario, many dentists and physicians cave in to the demands to avoid receiving a bad rating or reputation damage to their dental/medical practice on clinician-rating sites.

Yet, this is exactly the reason why dentists need to educate themselves in opioid addiction and follow the steps Mehta and his colleagues laid out for opening a dialogue about substance abuse with patients. It begins with making questions about substance abuse a routine part of recording medical histories on patients.

“Those questions can be very difficult for the average dentist to ask,” said Mehta, “but in this day and age, that is part of what we have to deal with.”

New State Practice Requirements Mandated, Lectures Given

Earlier this year, the Centers for Disease Control and Prevention (CDC) issued new guidelines for prescribing opioid medications for “chronic pain, excluding cancer, palliative, and end-of-life care,” which included utilizing non-opioid therapy for most chronic pain, prescribing the lowest possible effective dosage to avoid misuse, exercising caution with opioid prescriptions, and monitoring all patients closely.

Dental schools across the United States are also reevaluating their education curriculum. Schools in Massachusetts, for instance—namely Harvard dental, Boston University Henry M. Goldman School of Dental Medicine, and Tufts University School of Dental Medicine—have already altered their curriculum to help train students on how to “counsel patients and collaborate with other health professionals,” as well as educate dentists on opioid misuse and addiction.

West Virginia offers an open, online continuing education course, “Prescribing Opioids and Preventing Drug Diversion: The West Virginia Requirement,” for dentists already in practice to update their knowledge on the massive opioid epidemic in the state and how to avoid overprescription and recognize signs of opioid abuse.

Ever since the Journal of the American Dental Association brought light to the role dentists play in the opioid epidemic, several actions for opioid addiction awareness among the dental community have taken place. From the American Dental Association issuing a statement to their colleagues to address the prescription painkiller epidemic with resources for preventative action to a campaign launch by US Surgeon General Vivek Murthy at Health Journalism 2016 to promote substance-abuse awareness for all dentists and physicians.

With more opioid addiction awareness, perhaps significant change can occur within the dental community to prescribe fewer opioid painkillers to patients. While there is still much more left to go when it comes to educating dentists and physicians about the effects and consequences of opioid misuse, the fact that more medical professionals are willing to open a dialogue about substance abuse is a good sign for change in the future—perhaps even a brighter smile on patients’ faces.

Need Help?

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