Changing Our Approach

The United States is currently suffering through the worst epidemic of opioid abuse in the nation's history, and as prescribers, it is incumbent upon dentists to assess how our actions may have contributed to this situation and take an active role in limiting the number and size of future opioid prescriptions to reduce the incidence of misuse and ultimately, addiction and death from overdoses.

Our September Cover Story presents a brief history of opioid prescribing practices, examining the trends that may have contributed to the epidemic of abuse, and discusses how the profession of dentistry is changing its approach to pain management accordingly.

During my first 25 years of practice, I wrote many more prescriptions for opioids, but that is what we were taught to do. Now, I'm almost scared to write one. I think I've written about five opioid prescriptions total in the past several years; however, I also don't perform a lot of procedures that involve oral surgery, root canals, and other treatments that may require an opioid to manage greater pain. It's gotten to the point where I've considered not even registering with the US Drug Enforcement Administration for a prescriber number.

There are times when an opioid is appropriate, but it's a fine line. You really need to assess each patient's pain, pain tolerance, and potential for addiction. When opioids are prescribed in appropriate situations, they should be prescribed in a limited quantity and accompanied by patient education about the risks. In most cases, the combination of ibuprofen and acetaminophen provides my patients with excellent pain control, and I haven't experienced an increase in patient complaints about pain since adopting this regimen.

New laws in various states require practitioners to reconcile opioid prescriptions with patients' medication histories online, enter patient data into opioid prescribing registries, and even check for indications of previous or current abuse. It may seem complicated, but technology is enabling us to monitor opioid use more closely and better protect our patients. Check your state's laws regarding reporting and documentation requirements.

In addition, some makers of dental prescribing software will be charging an additional fee for the processing of opioid prescriptions. Coupled with the enhanced reporting and documentation requirements, it's becoming apparent that clinicians who wish to continue prescribing opioids will not only need to ensure that they are clinically appropriate but also that they are prescribed correctly from a compliance perspective.

Robert C. Margeas, DDS
Editor-in-Chief, Inside Dentistry
Private Practice, Des Moines, Iowa
Adjunct Professor
Department of Operative Dentistry
University of Iowa, Iowa City, Iowa
rmargeas_eic@aegiscomm.com