Opioids and Pain Treatment
MDS Position on Opioids
As part of 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.
The Opioid Epidemic
Most opioids prescribed to patients in the United States are written by physicians and other medical professionals for management of chronic (long-term) pain. Dentists with an appropriate license may also prescribe opioids, typically for management of acute (short-term) pain, such as severe tooth decay, tooth extraction, or root canals.According to the U.S. Department of Health and Human Services, health care providers began to prescribe opioid pain relievers at greater rates in the late 1990s, following reassurances from pharmaceutical companies that patients would not become addicted. Increased prescription of opioid medications led to widespread misuse of both prescription and non-prescription opioids before it became clear that these medications could indeed be highly addictive.
By 2016, at least 130 people died every day from opioid-related drug overdoses in the United States, and up to 40% of opioid overdose deaths involved a prescription opioid. Approximately 11.4 million people misused prescription opioids. In 2017, the U.S. Department of Health and Human Services declared a public health emergency and announced a Five-Point Strategy to Combat the Opioid Crisis.
Opioids and Oral Health: Get the Facts
In the late 1990s, dentists prescribed 15.5% of all immediate-release opioid prescriptions in the United States. However, the rate of opioid prescriptions written by dentists has decreased considerably in recent years. By 2012, the percentage of total U.S. opioid prescriptions provided by dentists decreased to 6.4%. In 2012, dentists ranked fourth among all medical specialties in opioid prescribing rates, but they were the leading prescribers of opioids for U.S. teens. Nationwide, the largest increase in oral health opioid prescriptions from 2010-2015 was among patients aged 11 to 18. This is a common age range for painful oral surgery procedures, such as wisdom teeth removal.
Here are some key facts about prescription opioids and teens:
- One in four teens report they've misused or abused a prescription drug at least once.
- Two out of three teens abusing prescription pain medications say they get them from family or friends.
- Prescription pain medications are especially dangerous for teens because their brains are still developing.
- Young people exposed to opioids by the end of high school have an increased risk of opioid misuse between the ages of 19-25.
While each patient is unique, many dentists are now considering non-steroidal anti-inflammatory drugs such as ibuprofen and acetaminophen as the first-line therapy for pain management. Across all age groups, dentists in the United States wrote nearly half a million fewer opioid prescriptions over a five-year period, from 18.5 million in 2012 to 18.1 million in 2017.
Massachusetts dentists are committed to being leaders in curbing opioid misuse by following responsible prescribing practices and utilizing non-opioid alternatives where appropriate. According to the Massachusetts Prescription Management Program, dentists issued 45% fewer opioid prescriptions in 2018 than in 2015, and they prescribed the medication in much smaller quantities.
What to Ask Your Dentist Before Taking Opioids
Before you agree to an opioid prescription for yourself or your child, get the facts and ask questions:
- Why do I need this medication–is it right for me?
- Are there non-opioid alternatives that could help with pain while I recover?
- What are the potential side effects from this medication?
- What if my family or I have a history of addiction with tobacco, alcohol, or drugs?
- Could this treatment interact with my other medications?
- If I need opioids, how many opioids are absolutely necessary? Can we start with a smaller prescription and then fill a second only if necessary?
- What should I do with unused opioid medicine?
Safe Administration and Storage of Opioid Medication
- DON’T allow children or teens to administer their own medication.
- DON’T take medicine in front of children who often mimic adults.
- DO monitor how many pills are in each of your prescription bottles.
- DO secure your prescriptions in the same way you would other valuables.
- DO keep medicine out of the reach of children.
- DO store medicine in its original container–the label on the bottle provides important information about the medicine.
- DON’T leave medicine in places that are easily accessible to children or pets.
Safe Disposal of Opioid Medication
- Discard expired or unused medications as soon as you are done with them.
- Check prescription dropbox locations to see if there is a permanent waste medication collection site in your town or city, or check for medication “takeback” programs with your local police or fire department, or authorized collection site, such as a pharmacy.
- If you cannot get to a dropbox or collection site, hide medication containers in the trash. DO NOT put them in your recycle bin!
- Keep medications in their original containers. Leave drug names visible to help identify the contents if they are accidentally swallowed. Cross out other personal information.
- Make the medication as difficult to consume as possible:
- For pills: Add some water or soda to dissolve them.
- For liquids: Add inedible material like cat litter, coffee grounds, or dirt.
- Close the lids and secure with tape.
- Unless otherwise instructed, DO NOT flush medications down the toilet.