July 4, 2011

Study Examines Role Of Dentists In Painkiller Abuse

Dentists may unknowingly be playing a major role in the abuse of opioids, a type of prescription analgesic used to treat acute pain, according to a cover article published in this month's edition of the Journal of the American Dental Association (JADA).

For the paper, which is entitled "Prevention of prescription opioid abuse: The role of the dentist," the nine authors--all dentists--participated in a two-day workshop, co-hosted by the Tufts Health Care Institute Program on Opioid Risk Management and the Tufts University School of Dental Medicine, both in Boston.

According to the article's abstract, "The purpose of the meeting was to synthesize available opioid abuse literature and data from a 2010 survey regarding West Virginia dentists' analgesic prescribing practices, identify dentists' roles in prescribing opioids that are used nonmedically, highlight practices that dentists can implement and identify research gaps."

"Many dentists really haven't even perceived there to be a problem," George Kenna, an assistant professor of psychiatry and human behavior at the Warren Alpert Medical School of Brown University, an addiction psychologist at the Center for Alcohol and Addiction Studies, and the corresponding author of the article, said in a statement on July 1.

According to Kenna, dentists are responsible for writing the third-highest number of immediate release opioids in the U.S., "but they often don't know the appropriate number of doses to prescribe, how many doses a patient uses, or most importantly what patients do with the leftover tablets they have."

These painkillers are "accumulated from various sources, not just dentists" and are "the primary source for prescription drug use initiation for children and adolescents," according to Kenna.

Kenna was joined by Dr. Richard C. Denisco, a medical officer at the Division of Epidemiology, Services and Prevention Research, National Institute on Drug Abuse in Rockville, Maryland; Michael G. O'Neil, an associate professor of Pharmacy Practice at the University of Charleston in West Virginia; Ronald J. Kulich, an attending psychologist at the Massachusetts General Hospital Center for Pain Medicine; and Paul A. Moore, the chair of the University of Pittsburgh Department of Dental Anesthesiology.

Rounding out the nine-person panel were William T. Kane, a dentist and the chair of the Missouri Dental Association Well Being Program; Noshir R. Mehta, chair of the Department of General Dentistry and director of the Craniofacial Pain Center at the Tufts University School of Dental Medicine; Elliot V. Hersh, professor of oral surgery and pharmacology and the director of the University of Pennsylvania School of Dental Medicine's Division of Pharmacology and Therapeutics; and Nathaniel P. Katz, program director of the Tufts Health Care Institute Program on Opioid Risk Management.

"Dentists can play a role in minimizing opioid abuse through patient education, careful patient assessment and referral for substance abuse treatment when indicated, and using tools such as prescription monitoring programs," they study authors wrote in their report. "Research is needed to determine the optimal number of doses needed to treat dental-related pain."

"Dentists cannot assume that their prescribing of opioids does not affect the opioid abuse problem in the United States," Kenna and his colleagues added. "The authors encourage dentists to incorporate practical safeguards when prescribing opioids, consistently educate patients about how to secure unused opioids properly, screen patients for substance use disorders and develop a referral network for the treatment of substance use disorders."

Among the recommendations mentioned specifically by the Brown University professor were writing prescriptions for small quantities of opioids, limiting the number of refills a patient can obtain, not prescribing the drugs to patients you are not familiar with, use prescription-monitoring databases to double-check a patient's drug-use history, advising patients to destroy or lock-up excess opioids, and making sure patients can not gain access to prescription pads in the office.


Image Caption: The Journal of the American Dental Association offers prescribing recommendations to dentists, the third-largest source of painkiller prescriptions. Credit: Mike Cohea/Brown University


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