Wednesday, March 29, 2017

Safely Prescribing Opioid Painkillers

prescription opioids
Over the last couple weeks and beyond, we have covered a number of topics regarding the American opioid addiction epidemic. Anything from fatal overdoses involving opioids and benzodiazepines to whom (e.g. doctors, pharmaceutical companies and wholesalers) should be held to account for their role in the epidemic we face. Until the time comes when there is at least some semblance of control over the situation, typified by around a hundred overdose deaths a day, concerted efforts to mitigate the risk of both opioid addiction and overdose are desperately required.

Earlier this month we discussed a new book that explored, in part, the relationship between primary care providers (PCPs), pharmaceutical companies and the cultural narrative promoting quick fixes by way of prescription drugs. While there is no question about the role PCPs and “big pharma” had in creating the perfect environment for a problem of epidemic proportions, placing blame does little good at the end of the day. Financial restitution to the loved ones of overdose death victims, maybe being the one exception.

If you were to create a list of the various people, entities and “accepted” practices that led to the scourge of prescription opioid abuse, it would be long and complex. So, if effective measures are to be taken in scaling back the prescribing of opioid and subsequent abuse rates, blame needs to be cast aside, and the entire field of general medicine and mental health need to join forces to create a long list of ways to amend the practices that resulted in what we have today.

 

The Many Faces of Pain


To be sure, medical doctors prescribe the market share of opioid painkillers. Whether that be in emergency departments and primary care practices across the country. However, the human mouth can be a hotbed for unwelcome pain. The maxillofacial region of the body is densely packed with nerves, as a result pressure from the introduction of wisdom teeth or the run of the mill tooth decay can cause you serious discomfort. The obvious choice of treatment for such pain is prescription opioids like Vicodin (hydrocodone combined with acetaminophen) and Percocet (oxycodone combined with acetaminophen).

Given that most Americans do not have dental insurance, such peoples’ ability to take effective measures at treating the problems that lead to chronic mouth pain is diminished. A reality that leads to a significant number of people needing to use opioids like band-aids for their pain. You may be surprised to learn that dentists prescribe opioids on a regular basis. What’s more, many prescription opioid addicts began their road to addiction in a dentist's office.

 

Opioids As A Last Resort


If you have been following news about the epidemic, there is a chance that you learned of the American Medical Association's (AMA) apprehension to proposed prescribing guidelines from the Centers for Disease Control and Prevention (CDC). The organization called on doctors to undergo specific training, limit their prescribing practices and only dole out opioid painkillers when it is deemed absolutely necessary. Why the AMA would be opposed to what would appear to be common sense prescribing, has left many experts scratching their heads.

On the other hand, the American Dental Association(ADA) appears to fully realize the role dentists have in the current epidemic, and the change that could be affected by taking a more conservative approach to prescribing. In fact, the ADA is hosting a webinar called Opioid Prescribing in Dental Medicine: Balancing Our Compassion for Patients with Social Responsibility. The event will be held April 13 from 2-3 p.m. (CDT).

The organization's website states that the webinar will “focus on strategies for dentists to prescribe opioids, when necessary, in a safe manner — one that provides their patients with adequate and appropriate analgesia while simultaneously safeguarding against misuse, abuse, overdose and diversion of the drugs.” If you work in the field of dentistry, or have a vested interest in the topic, you can register for the event by clicking here. The ADA says that participants will be able to:
  • Discuss the balance between the dentists' obligation to provide pain relief with an equally important responsibility to not expose patients to risk of addiction and not create opportunities for drug diversion.
  • Recognize the risks to patients, dentists and society associated with opioid prescribing.
  • Formulate a rational and practical plan for improving risk mitigation within dental practices.

 

It Takes A Village…


If the United States is ever to affect change regarding prescription opioid use and abuse, it will require everyone working in the field of medicine. Just as it takes a village to raise a child, it will likely take a society to end an epidemic. Curbing prescribing practices is just one aspect of the effort. Properly educating patients per the risks of opioid use and providing patients who have become dependent on such drugs with the addiction support resources is vital. If you or a loved one is struggling with opioid abuse, please do not hesitate to reach out to us.

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