Preventing Opioid Misuse
The opioid abuse epidemic has become a public health crisis with devastating consequences across Massachusetts and the United States. According to the Centers for Disease Control and Prevention (CDC), the number of people who died from a drug overdose in 2021 was over six times the number in 1999. The number of drug overdose deaths increased more than 16% from 2020 to 2021. Over 75% of the nearly 107,000 drug overdose deaths in 2021 involved an opioid. Dentists play a vital role in preventing the abuse and misuse of prescription medications. To help support members in this mission, the MDS is dedicated to sharing the latest information, news, resources, and tools.
The MDS is currently supporting the Act Establishing a Dentist Diversion Program legislation. To learn more see the Issue Card.
The MDS is committed to helping its members provide safe and effective pain control for their patients by utilizing evidence-based prescribing practices applying non-pharmacological strategies as well as non-opioid and opioid pain medications as appropriate.
As part of former Governor Charlie Baker’s Working Group on Dental Education on Prescription Drug Misuse, Massachusetts dentists were the first in the nation to partner with the Commonwealth’s three dental schools to announce a set of dental education core competencies for the prevention and management of prescription drug misuse. Massachusetts dentists also worked with policymakers to enact landmark legislation limiting opioid prescriptions to a seven-day supply for minors and first-time adult prescriptions. This legislation, passed in 2016, also included mandatory continuing education and prescription monitoring requirements.
The MDS supports:
- Mandatory continuing education in prescribing opioids and other controlled substances
- Statutory limits on opioid dosage and duration of no more than seven days for the treatment of acute pain, consistent with the U.S. Centers for Disease Control and Prevention evidence-based guidelines
- Dentists registering with and utilizing Prescription Drug Monitoring Programs (PDMPs) to promote the appropriate use of opioids and deter misuse and abuse
In 2018, the American Dental Association (ADA) announced a policy to combat the opioid epidemic impacting the United States. This policy is fully aligned with the position of the MDS.
With the growing attention on the opioid crisis, many patients are concerned about taking opioid substance Schedule II drugs for pain management. Massachusetts state law (M.G.L 94c s 18) gives patients the right to request a partial fill on a Schedule II drug to avoid having extra pills on hand. This means that if you prescribe a five-day pain management script, a patient can ask the pharmacist to reduce the quantity to a shorter duration (e.g., three days).
Dentists are required to have an informed conversation with patients when prescribing Schedule II prescriptions to review why you have written the script for the suggested length and explain that they have the right to opt for a partial fill if desired. This may eliminate some of the concern surrounding the prescription. If a patient chooses to receive a partial fill, the remaining quantity would be void. A patient would need to come back to your office for an additional prescription if required. You should include the following on the prescription: “Partial Fill Upon Patient Request.“
- Prescribe for legitimate dental purposes only.
- Prescribe for patients of record only.
- Review medical history prior to prescribing.
- Periodically update pharmacology and pain management training.
- Counsel and follow up with patients regarding proper compliance.
- Avoid self-prescribing.
- Issue prescriptions in a truthful manner.
- Never prescribe without proper treatment records.
- Safeguard prescription pads.
- Learn to identify high-risk substance abuse patients.
Richard S. Harold, DMD, JD, FCLM. Prescription Writing for Dentists: Ethical and Legal Guidelines.
Reprinted from the Journal of the Massachusetts Dental Society.
Effective October 15, 2016, all prescribers are required to check MassPAT each time you prescribe a Schedule II-III opioid and when prescribing a benzodiazepine or DPH designated Schedule IV-VI for the first time. The PMP shows a patient’s prescription history for the prior 12 months. Data is reported into the PMP by all Massachusetts pharmacies and by out-of-state pharmacies delivering to people in Massachusetts. The PMP prescription history data informs clinical decision-making to help prevent or stop harm from duplicate drug therapy, prescription drug misuse, abuse, and diversion.
This system replaces the PMP Virtual system.
Practitioners who prescribe controlled substances are required by the State of Massachusetts to obtain training in pain management and controlled substance abuse every license renewal cycle.
Options to Fulfill Requirement: