One of my priorities during my term as president of the CDA is to continue efforts to increase awareness of opioid use and misuse. I am proud to say that dentistry has played a pivotal role in helping to reduce the number of opioid prescriptions written by emphasizing to their patients the proven effectiveness of NSAIDs and acetaminophen for acute pain management. I am on the Board of Directors for the JP Opioid Interaction Awareness Alliance (JPOIAA), which is a non-profit organization tasked with providing education and awareness to the public and to healthcare professionals about the dangers of opioids, benzodiazepines and other substances taken alone or, more concerning, in combination. Each year JPOIAA uses funds from their Save-a-Life Golf Tournament to provide scholarships to pharmacy students at Regis and the Skaggs School of Pharmacy for those who are interested in supporting the mission of JPOIAA. If you would like to learn more about this organization, please visit jpopioidalliance.org.
Kevin M. Patterson, D.D.S., M.D.
CDA President, 2024/2025
By Suzi Stolte, Director of Marketing and Communications, JP Opioid Interaction
Awareness Alliance From the 2024 Summer Journal of the Colorado Dental Association
As of 2022, opioid prescriptions have decreased for the 13th consecutive year, according to the 2023 American Medical Association Overdose Epidemic Report.[1]
The report states, “In the past decade, physicians and other health care professionals, have reduced opioid prescribing in every state — by nearly 50% nationally. State prescription drug monitoring programs (PDMPs) are highly utilized in every state — more than 1.3 billion queries of PDMPs in 2022. Buprenorphine dispensed by community pharmacies for the treatment of opioid use disorder (OUD) nearly doubled in the past 10 years, and naloxone dispensed has increased to 1.7 million prescriptions since 2018.”
Colorado’s dental community can be proud of its part in this decreased prescribing. Over the last five years, awareness of the opioid issue has drastically increased among the dental community. This understanding has contributed to the overall reduction in opioid prescribing, the reduction in the number of pills per prescription, and an increased use of the Colorado Prescription Drug Monitoring Program.
This decline in dental prescribing was noted in a January 2024 article in the Journal of the American Dental Association titled, “Trajectories of opioid prescribing by general dentists, specialists, and oral and maxillofacial surgeons in the United States, 2015-2019.” [2] The authors identified variations in dentists’ opioid prescribing rates noting that 60% of dentists decreased prescribing rates by 30% to 83%. However, they also reported that 3.4% of general dentists and specialists consistently prescribed at high rates, indicating that more targeted education is needed to help direct decision-making in regards to opioid prescribing.
Another factor contributing to the reduction in opioid prescribing is the requirement that all scheduled medications are now mandated to be prescribed electronically. This change means the old practice of giving the patient a written “just in case you have pain” prescription is unnecessary, and prescriptions can now be sent electronically on an as-needed basis. This change helps ensure that large numbers of opioids are not sitting unused in medicine cabinets with the possibility of being diverted for use by someone other than the patient.
The Case for Non-Opioid Pain Treatment
Oral and maxillofacial surgeons have been at the forefront of making recommendations for the treatment of acute dental pain. They are emphasizing the use of ibuprofen and acetaminophen, noting that their combination is more effective than narcotics. They also emphasize the benefits of using delayed long-acting local anesthesia such as Exparel in managing acute dental pain.
In 2020, the American Association of Oral and Maxillofacial Surgeons published a white paper titled, “Opioid Prescribing: Acute and Postoperative Pain Management.” [3] It offered recommendations for the management of acute and postoperative pain with an emphasis on the benefits of non-opioid treatments. An article from the February 2024 issue of the Journal of the American Dental Association [4] also suggested that NSAIDs alone or combined with acetaminophen are more effective in reducing postoperative pain than opioid medications. Following these prescribing guidelines is one important way dentists can help reduce the misuse and diversion of opioids.
An Emerging Concern
As noted in the 2023 Overdose Epidemic Report, there has been an increase in the use of buprenorphine (Suboxone) for treating opioid use disorders and addiction. This is good news for those needing treatment but also comes with risks dentists should watch for as patients may be at risk of developing cavities from the use of this orally dissolving medication. An article in the April 2024 issue of Journal of the American Dental Association titled, “Orally dissolving buprenorphine for opioid use disorder linked to caries” [5] provides guidance for dentists with patients taking this medication.
Prescribing Down; Deaths Slowly Decreasing
While drug-related overdoses and deaths may be slowly decreasing according to provisional data from the Centers for Disease Control and Prevention (CDC), work to educate dentists and patients must continue. The CDC stated that drug overdose deaths decreased from 3% from 2022 to 2023 in the U.S., which is the first annual decrease in drug overdose deaths since 2018. [6]
Raising Awareness
Colorado is home to multiple organizations working to prevent opioid deaths and reduce the stigma associated with substance use disorders. Some are large like the Center for Prescription Drug Abuse Prevention/Colorado Consortium for Prescription Drug Abuse Prevention (corxconsortium.org), which is housed at the Skaggs School of Pharmacy and Pharmaceutical Sciences. With access to grants and federal funding, they help facilitate research, identify evidence-based clinical practices, educate healthcare and public health practitioners, and coordinate Colorado’s response to the misuse and abuse of opioids. Others are small, all-volunteer nonprofits like JPOIAA (jpopioidalliance.org) that focus on providing scholarships for pharmacy students to ensure the next generation of pharmacists is knowledgeable concerning opioid issues.
Colorado is also active in recognizing International Overdose Awareness Day (IOAD) on August 31. IOAD is the world’s largest annual campaign to end overdoses. Its purpose is to raise awareness about prescription opioid overdose risk, provide information on available community services, and prevent drug-related harm. The 2024 theme is “Together We Can” highlighting the power of community when everyone works together. The dental community can be proud that it exemplifies that collaboration.
__________________
1 Overdose Epidemic Report 2023 American Medical Association. Accessed June 9, 2024. AMA Overdose Epidemic Report (ama-assn.org).
2Tumader Khouja, BSD MPH PhD, Nilesh H. Shah, PhD, Katie J. Suda, PharmD, MS, Deborah E. Polk, PhD. Trajectories of opioid prescribing by general dentists, specialists, and oral and maxillofacial surgeons in the United States, 2015-2019. Accessed June 9, 2024. https://jada.ada.org/article/S0002-8177(23)00598-6/abstract#%20
3 American Association of Oral and Maxillofacial Surgeons. (2017) (Revised 2024). Opioid Prescribing: Acute and Postoperative Pain Management [White paper]. https://www.aaoms.org/docs/govt_affairs/advocacy_white_papers/opioid_prescribing.pdf?gclid=CPOw34vI59YCFUSRfgodnOwGCQ
4 Alonso Carrasco-Labra, DDS, MSc, PhD, Deborah E. Polk, PhD, Olivia Urquhart, MPH, Tara Aghaloo, DDS, MD, PhD, J. William Claytor Jr., DDS, MAGD, Vineet Dhar, BDS, MDS, PhD, Raymond A. Dionne, DDS, MS, PhD, Lorena Espinoza, DDS, MPH, Sharon M. Gordon, DDS, MPH, PhD, Elliot V. Hersh, DMD, MS, PhD, Alan S. Law, DDS, PhD, Brian S.-K. Li, Paul J. Schwartz, DMD, Katie J. Suda, PharmD, MS, Michael A. Turturro, MD, Marjorie L. Wright, DMD, MPH, Evidence-based clinical practice guideline for the pharmacologic management of acute dental pain in adolescents, adults, and older adults: A report from the American Dental Association Science and Research Institute, the University of Pittsburgh, and the University of Pennsylvania. Available in PMC 2024 March 07. Published in final edited form as: J Am Dent Assoc. 2024 February ; 155(2): 102–117.e9. doi:10.1016/j.adaj. 2023.10.009.
5 Stuart L. Segelnick, DDS, MS; Mea A. Weinberg, DMD, MSD, RPh. Orally dissolving buprenorphine for opioid use disorder linked to caries published April 30, 2024. https://doi.org/10.1016/j.adaj.2024.03.001
[6] Center for Disease Control and Prevention’s Nation Center for Health Statistics, May 15, 2024. U.S. Overdose Deaths Decrease in 2023, First Time Since 2018 [Press release}. https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2024/20240515.htm#:~:text=Provisional%20data%20from%20CDC’s%20National,drug%20overdose%20deaths%20since%202018.
