Opioid addiction is one of the most serious issues facing our country today. In 2020, 68,630 people in the United States died of an overdose involving opioids, a number that has been rising steadily for the past decade.
Of those deaths, more than 16,000 were a result of prescribed opioids ― that’s more than 40 deaths per day. While opioid prescriptions in the United States have been declining since 2012, U.S. health care providers still prescribe more opioids per capita at higher doses and throughout more stages of treatment than providers in any other country.
And among these providers, dentists are a leading prescriber of opioids. Learn what you can do to help stop opioid abuse and addiction.
The role dentists play
In the United States, dentists are the second-largest group of medical specialists who prescribe opioids and dispense about 9% of the country’s total opioid prescriptions. While there are some positive trends in opioid prescribing among dentists, studies suggest further steps need to be taken to reduce these numbers.
- Dentists are the leading source of opioid prescriptions for children and adolescents.
- Opioids prescribed by dentists have been associated with subsequent abuse, particularly among adolescents and young adults.
- In the U.S. between 2011 and 2015, 29% of the opioids prescribed by dentists exceeded the dosage recommended for acute pain, and half of these prescriptions were for more than the recommended three-day supply of medication.
- U.S. dentists prescribe more opioids than dentists in similar countries ― a lot more. For example, in 2016, 22.3% of dental prescriptions written in the U.S. were for opioids, while only 0.6% of English dental prescriptions were ― that’s a proportion 37 times greater here than in England. U.S. dentists also prescribed more powerful opioids than the English dentists did.
On the good news front, opioid prescription rates are dropping significantly, according to a recent study by the American Dental Association (ADA). The percentage of opioid prescriptions written for nonsurgical visits declined during each year between 2012 and 2019, as did the quantity and strength of these prescriptions.
That said, the study acknowledged that the overall opioid prescription rate is still too high and prescriptions are being written unnecessarily when alternative treatments would be more effective.
Effective alternatives to opioids
While opioids can be an effective to tool to treat your patients’ pain, they’re not the only one ― and may not even be the most effective. Non-opioid analgesics, such as a combination of acetaminophen and ibuprofen, can achieve equivalent or superior control of oral pain.
The ADA offers a helpful guide on prescribing non-steroidal anti-inflammatory drugs (NSAIDs) as an alternative to opioids.
|Anticipated pain level||Oral analgesic options|
|Mild||Ibuprofen 200-400 mg as needed for pain every 4 to 6 hours|
|Mild to moderate||Ibuprofen 400 to 600 mg fixed interval every 6 hours for 24 hours|
Ibuprofen 400 mg as needed for pain every 4 to 6 hours
|Moderate to severe||Ibuprofen 400 to 600 mg plus acetaminophen 500 mg fixed interval every 6 hours for 24 hours|
Ibuprofen 400 mg plus acetaminophen 500 mg as needed for pain every 6 hours
|Severe||Ibuprofen 400 to 600 mg plus acetaminophen 650 mg with hydrocodone 10 mg fixed interval every 6 hours for 24 to 48 hours|
Ibuprofen 400 to 600 mg plus acetaminophen 500 mg as needed for pain every 6 hours
Best practices for opioids
If you do decide that prescribing an opioid to your patients is the best option, taking some basic precautions can help ensure safety and minimize the risk of abuse. The ADA suggests the following:
- Conduct a medical and dental history to determine your patient’s current medications, potential drug interactions and history of substance abuse.
- Discuss with your patients how to prevent the abuse of prescription opioids, and how to store and dispose of them.
- Follow, and continually review, the Centers for Disease Control and Prevention and state licensing board recommendations for safe opioid prescribing.
- Register with and use prescription drug monitoring programs to deter the misuse, abuse and diversion of these substances.
- Consider nonsteroidal anti-inflammatory analgesics as the first-line therapy for acute pain management.
- Recognize multimodal pain strategies for acute postoperative pain management to eliminate the need for opioid analgesics.
- Consider coordinating with other treating doctors, including pain specialists, when prescribing opioids for management of chronic orofacial pain.
- Seek continuing education in addictive disease and pain management related to prescribing opioids.
Delta Dental takes opioid abuse prevention seriously
Delta Dental is committed to fighting opioid misuse and abuse in our country. But we can’t do it without your help.
“Dentists play a key role in opioid abuse prevention as dentists are often the first health care provider to prescribe an opioid to young people,” said Dr. Jessica Buehler, Delta Dental’s Director of Dental Affairs.
Dr. Buehler stressed that opioid prescriptions should be kept to minimum, and alternative medications should be sought whenever possible.
“The reality is that nearly all opioid subscribing by dentists can and should be prevented through appropriate use of NSAIDs,” Dr. Buehler said, “which offer similar-to-better pain control as well as additional anti-inflammatory support.”
Finally, Dr. Buehler strongly encouraged dentists to attend one of the many available continuing education courses on pain management to learn more about opioids, their alternative and how to minimize the risks of abuse and addiction.
“Expanding your toolkit for dealing with pain management can help curb opioid addiction in the U.S.,” she said.