1. The Role of Dentists in Preventing Opioid Abuse
Understand the scope of the problem
Understand dentists role in addressing the problem
Recommendations for prescribing
Strategies to reduce opioid abuse
Gary W. Allen, DMD,MS
Vice President of Dental Services
Advantage Dental

2. Opioid Prescriptions by Age and Physician Specialty
JAMA 2011, Characteristics of Opioid Prescriptions in 2009

3. Dentist Opioid Prescribing Practices
85% oral surgeons almost always prescribe opioid analgesics
Average Rx = 20 tabs prn pain (range 10 – 40)
24% prescribe more than would generally be necessary
Journal of Oral and Maxillofacial Surgery, September 2013
2010 Survey West Virginia dentists: 36% expect their patients to have leftover drugs
JADA 2011, Prevention of prescription opioid abuse: The role of the dentist

4. Unused opioid analgesics and drug disposal following outpatient dental surgery: A randomized controlled trial
79 patients had wisdom teeth removed
94% received opioid prescription
Average prescription = 28 opioid pills
After 24 hrs pain scale = 5
After 2 days pain scale = 3
After 3 weeks, average pills remaining = 15
Extrapolate to U.S. population: 100 million unused opioid pills
University of Pennsylvania Perelman School of Medicine
Drug and Alcohol Dependence, Sep 16, 2016
Providing information about drug disposal programs led to 22 percent increase in number of patients who disposed of unused medication

5. Established prescribing behaviors
Prescribing for the most severe outcome
Patient expectations and demands
Unaware or disregard of the evidence for NSAID/APAP in combination
JADA 147(7) July 2016

6. Recommended Opioid Prescribing Guidelines for Dentists
Ask about other medications & use the PDMP
Consult with PCP/BH provider for patients with history of substance abuse
Do not offer refills
Prescribing over the phone is discouraged
Use combination opioids when Rx is necessary
Oregon Opioid Prescribing Guidelines Task Force
Dental Subgroup Oct 12, 2016
Documents/oregon-recommended-opioid-guidelines-dentists.pdf

7. Recommended Opioid Prescribing Guidelines for Dentists (cont.)
Prescribe in small doses (should not exceed 10 tablets)
Follow stepwise guidelines for acute pain management
Mild to moderate: ibuprofen
Moderate to severe: ibuprofen + APAP
Severe: ibuprofen + hydrocodone/APAP
Inform patients how to secure medication and dispose of leftover medication
Should not prescribe more than 7 days from last appointment – assess in clinic
Oregon Opioid Prescribing Guidelines Task Force
Dental Subgroup Oct 12, 2016
Documents/oregon-recommended-opioid-guidelines-dentists.pdf

8. Strategies to Reduce Opioid Abuse
OHA: Communicate guidelines; engage dental professional organizations & Board of Dentistry
CCO Measures
CCO opioid prescribing reports & monitoring
Quantity limits
Oregon legislature: HB 2114
Limits to 7 day supply
For <18 yrs: discuss with parent/guardian
If >7 days, document diagnosis, why opioid necessary & why non-opioid alternative is not appropriate

9. Advantage Dental Measures to Reduce Opioid Abuse
Educate & reinforce with providers
Monitor provider prescribing patterns
Required PDMP enrollment for OHP provider credentialing
Incentive metrics

10. Best Drugs for Dental Pain
Forget about Vicodin, Percocet, and other potentially dangerous, addictive opioids.
Over-the-counter painkillers may work better.
By Teresa Carr
January 24, 2017
To find an authorized medication take-back program near you, go to DisposeMyMeds.org or DEAdiversion.usdoj.gov
and search for "drug disposal.” Or call the DEA’s Registration Call Center at
Health Care
Countless Opioid Pills Unused by
Dental-Surgery Patients
Sept. 27, 2016