When a treatment results in severe oral pain, some dentists prescribe opioids for pain relief. However, this seemingly innocent act of medical care can lead to opioid abuse, a growing problem throughout our nation which poses a significant risk to the economy and public health.
Prescription opioids are one of the biggest factors of the opioid overdose epidemic in the US. Over 40% of all the nation’s deaths caused by opioid overdoses in 2016 were connected with a prescription opioid. Even when the medication is prescribed by a qualified healthcare practitioner, regular opioid use frequently leads to dependence which can escalate into addiction, overdose and even death.
How you can help
As you decide the type of pain relief to prescribe a patient, dentists play a vital role in managing the nation’s opioid crisis. Correcting the problem begins with changing the way you practice. It’s important for dental professionals to work together hand-in-hand to transform the way they treat patients, curbing excessive pain medication prescriptions in favor of healthier, safer alternatives.
The solution is three fold:
- Understanding patients’ medical histories
- Practicing dosage control
- Ongoing education about alternative ways to manage pain.
Getting to the root of the problem
The first problem dentists are faced with in terms of the opioid crisis is patients requesting it for pain relief without properly understanding the medication or its potential long-term effects. When one of your patients requests opioids, it’s likely they know someone who underwent painful medical treatment and experienced blissful pain relief after being prescribed opioids.
In the majority of cases, the patient is looking for something as simple as quick, effective pain relief. However, sometimes, the patient is looking for something more sinister and dangerous than easing the pain caused by oral stitches. As a dental professional, it’s your job to determine which patients you can safely prescribe opioids to and which ones are at risk of becoming opioid dependent if you do.
Tips for effective pain management
It’s important to understand that pain medication needs to be considered on a case-by-case basis. It’s subjective, not objective — a treatment which may be incredibly painful for one patient might just be mildly uncomfortable for another. You can’t prescribe the same pain relief medication to all patients who undergo the same dental treatment.
As a dentist, it’s your responsibility to help the patient manage their pain so they experience as quick and painless a recovery as possible. As well as helping patients lead a normal life in the days following painful surgery, medication is also integral to the healing process, reducing inflammation and encouraging full recuperation.
Since pain management is an unavoidable part of dentistry you have to deal with on a daily basis, here are some tips to help your patients recover without putting them at risk.
Know your patients’ medical histories
While you’re likely to be familiar with your patients’ dental histories, prescriptions can be issued by a number of different clinicians. This means your patients could be receiving opioid prescriptions from elsewhere without your knowledge.
To successfully identify at-risk patients, it’s important you track your patients’ medication history as thoroughly as possible. Many states have databases listing medications patients have been prescribed which dental practices can access. Check the laws in your state for more information about how to gain access.
Consider alternative pain relief
Whenever possible, prescribe a patient with non-opiate pain relief. Providing alternating doses of over-the-counter medications, such as acetaminophen and ibuprofen, is often just as potent as opioids in pain management following oral procedures.
According to ADA, nonsteroidal anti-inflammatory analgesics are an effective method of acute pain management. The association also recommends you consider using multimodal opioid-sparing strategies (pre-treatment with NSAIDS, for example) and long-acting local anesthesia as a means of avoiding prescribing opioids.
Combining alternative pain relief medication with regular recovery monitoring, dressing changes and tissue healing support often means you can avoid including opioids in your treatment plans entirely.
Follow the CDC guidelines
If you do prescribe an opiate for acute pain following dental surgery, it’s important to follow the CDC guidelines:
- Prescribe the smallest amount of medication needed for effective pain relief. Enough for three days or less is usually sufficient. Rarely will you need to prescribe more than one week’s worth of medication.
- Issue no more medication than needed for the expected duration of severe pain.
By limiting a patients’ access to the powerful pain relief, they’ll check back in with your dental practice sooner, allowing you to manage the next steps of their recovery effectively.
Take care with adolescents
If you find yourself issuing a prescription to an adolescent after their third molar extraction, you might be the first to prescribe them an opioid. Research has shown that the medical use of prescription opioids often leads to the non-medical use of opioids in highschool seniors. To avoid creating dependency, consider non-opioid analgesics when prescribing pain relief to this group of patients.
Discuss the effects of opiates with your patients
The most important aspect of pain management as a dentist is talking to your patients and ensuring they understand opioids and their potential effects. Talk about any other medications they’re taking which could be affected by opioids and whether they (or anyone in their family) currently have or have had a problem with substance abuse.
It’s also crucial you carefully explain the risk of taking opioids. Describe exactly how the patient should take the medication, how long they should take it for, things they should avoid combining it with (e.g. alcohol) and how to safely store it at home.
Things to keep in mind
When hiring new staff, whether permanent or temporary, it’s important all dental professionals who work in your office understand your practice’s stance on opioids. When hiring staff from Cloud Dentistry, look for people who list experience prescribing pain relief to people at risk of developing opioid dependency.
Another action to consider is documenting your steps of dealing with opioid prescriptions in your policy manual and updating it as you revise your approach. This way your staff always have something solid to refer back to if they’re ever unsure when it comes to prescribing pain medication.
You should also stay as up-to-date as possible on the latest information regarding prescribing pain medication and opioids. Attending seminars, courses and lectures on this topic forms part of your ongoing education which counts toward the hours required to renew your dental license. Equally, it’s important you encourage your dental staff to keep on top of the latest best practices with regards to pain management, too.
The opioid crisis isn’t going to disappear overnight. It will continue to be a prominent issue at the forefront of dentistry as dental professionals work together to decrease addiction levels to narcotic medications across the nation. The solution begins with individual dentists doing what they can in local practices to safely and effectively manage patient recovery.
Dentists play a hugely important role in helping the opioid crisis in their local communities, not just for patients’ oral health, but for their health in general. It’s important you recognise the impact you can make on your patients and do whatever you can to help the cause.