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Op-Ed: For Some Dentists, Prescribing Opioids Reflexively Is a Bad Habit

In the end, providers have the power to stop the opioid epidemic; despite guidelines and new regulations, treatment is still a judgment call

Dr. Cecile A. Feldman
Dr. Cecile A. Feldman

It can start with Percocet, prescribed after a wisdom tooth extraction, or a Vicodin refill to dull the pain of an infected tooth. Far too often, a visit to the dentist leads to addiction, to patients scoring heroin when the refills run out, to a teen’s fatal overdose from leftover pills, discovered in the family medicine cabinet.

Many don’t realize that dentists and oral surgeons have played a big role in America’s devastating opioid epidemic. But it’s not surprising when you consider that a large part of our job is managing acute and chronic pain. In 2012, dentistry ranked fourth on the list of medical professionals prescribing opioids, accounting for 18.5 million, according to the American Journal of Preventive Medicine.

Although many providers are now more cautious about prescribing the drugs, in many states there is little to discourage them from business as usual. As oral health providers, we must be on the frontlines of change. That’s why the American Dental Association (ADA) last month became one of the first professional health organizations to issue a policy that restricts prescription opioids and calls for continuing education for providers. In addition to seven-day prescription limits and educational requirements, it recommends programs that monitor patients’ prescription drug history.

In New Jersey, which has some of the strictest regulations in the nation, some policies recommended by the ADA are already the law. In some cases, they are even more stringent than association guidelines. New Jersey, for instance requires five-day prescription limits. Violations can result in criminal charges.

Power to stop the epidemic

But in the end, it is providers who have the power to stop the epidemic, and despite guidelines and new regulations, treatment is still a judgment call that can have grave consequences, so they must be vigilant.

Dentists and oral healthcare specialists still have the freedom to determine what constitutes the lowest effective dose or decide whether to extend an initial prescription beyond five days. In the past, many have written prescriptions to placate patients who expect it, because when they’re hurting, they’re used to leaving the doctors’ office with that piece of paper in hand, convinced that opioids are the answer.

New evidence proves otherwise. A study published in the November issue of the Journal of the American Medical Association revealed that a combination of ibuprofen and acetaminophen relieved pain as effectively as opioids.

At the Rutgers School of Dental Medicine, and dental schools across the nation, we are educating a new generation of providers who are keenly aware of the deadly effects of opioid abuse, who, hopefully, will never develop the habit of prescribing opioids reflexively. On our school’s clinic floor, students are accustomed to technology that easily allows them to spot red flags in medical histories, which may signal a struggle with addiction.

They learn that patient education, and managing expectations, are key to preventing opioid abuse. Unlike providers of the past, the dentists of tomorrow will be expected to explain that when it comes to opioids, there are better options. Dentists of the future, and dentists of today, must let patients know that while we can greatly reduce pain, complete and immediate relief is an unrealistic goal.

Compared with the dangers of addiction, enduring a little discomfort is worth it.

Dr. Cecile A. Feldman is dean of the Rutgers School of Dental Medicine.

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