Beth Macy's book, Dopesick: Dealers, Doctors and the Drug Company that Addicted America, chronicles the opioid crisis and its impact on three regions of western Virginia over two decades. The book (as well as the companion television series on Hulu) is a comprehensive account of the effect opioids had on communities and families, along with the challenges and pain felt by those who experienced the results of opioid addiction firsthand.
Dentistry's role in the opioid crisis
The current crisis in opioid addiction has been with us for a number of years. Dentistry has played an important role from the very beginning. As the current crisis began to unfold, dentistry, like others in healthcare, took a long hard look at itself and noted that in too many cases, opioids were being used when alternative approaches were available or when prescriptions were being written for too many pills.
Managing the opioid crisis
Organized dentistry, including the American Dental Association, Virginia Dental Association, specialty groups such as the American Association of Oral and Maxillofacial Surgeons, and others, stepped up and took a number of actions, such as:
- Creating dentist and patient education materials, including posters that dentists can share with patients in their offices
- Engaging in promotions such as national prescription take-back day, along with providing members resources to help them participate
- Supporting mandatory continuing education in prescribing opioids and other controlled substances while also providing dentists with ongoing continuing education on the issue (including virtual CE during the pandemic), and
- Implementing internal policies and guidelines on the appropriate use of opioids.
The ADA, in partnership with the Universities of Pennsylvania and Pittsburgh, is currently in the process of developing a clinical practice guideline on acute dental pain management, targeting a 2022 release date.
What you can do
Dentists are being asked to have conversations with patients about the risks of opioids and opioid alternatives, as well as safe approaches to disposal. Dentists are also asked to follow CDC guidelines when prescribing, and those dental payers with ties to pharmacy plans are reviewing dentist prescribing habits, providing individual prescriber feedback as appropriate.
We also encourage our network dentists to remain on top of the most current prescribing guidelines, including the Virginia Administrative Codes. The code notes that "A prescription for an opioid shall be a short-acting opioid in the lowest effective dose for the fewest number of days, not to exceed seven days as determined by the manufacturer's directions for use, unless extenuating circumstances are clearly documented in the patient record;" that it does not exceed 50 MME without careful consideration and documentation in the patient records; prescriptions of over 120 MME can only be done in consultation with a pain specialist along with justification in the patient record; and that for those prescriptions over seven days, the patient must be re-evaluated and a reason for continued need noted in the patient record, along with consulting the Prescription Monitoring Program.
What we're doing to help
Dental benefit companies, including Delta Dental, are taking steps to communicate with clinicians and patients about opioids. Patients are being advised to ask their dentist or oral surgeon about alternatives to opioids, potential side effects and drug interactions, and are also given recommendations on safe storage and disposal.
Delta Dental of Virginia is working with the dental community and others to more aggressively address the issue. We are initiating corporate collaborations, including a partnership with Leidos, which will include member and dentist education, monitoring and reporting, and providing feedback directly to the network dentists to inform them of our findings.
Michael D Weitzner, DMD, MS
Dental Director, Delta Dental of Virginia
