Prescribing smarter: How we can have great influence on America’s opioid crisis
From the ADA New Dentist Now Blog, by WSDA member Dr. Joe Vaughn: Pain Killers. Opioids. Drugs. Are they on your mind today? Because they’re on mine. With every walk-in. With every extraction. With every patient who looks me in the eye and says: “Doc, can I get a little something for pain?”
“Sure,” I say. And then I walk back to my computer, stare at my screen, and wonder what to do. What do I give? How much? Do they really need it?
I don’t know about you, but my answers have certainly changed.
A few months ago, my prescription pad was a care-free, generous space. I wanted my patients comfortable. I wanted them pain-free. I wanted a “good-experiences-only” policy. So I took care of their pain and in turn thought I was taking care of my patients.
Vicodin, Percocet, Norco, Oxy, hydro... usually whatever the patient requested. If I took a tooth out, they got a narcotic. If they walked in with pain, they got a narcotic. We’re not talking outrageous amounts here. But in these moments, this is what I thought good health care looked like.
Which didn’t last long. And now things look much different in the space where I practice. I still take teeth out every day. But opioids are few and far between.
Well, it’s experience. Good ol’ anecdotal evidence. It’s discussions with colleagues. And then it’s being a part of an organization that has committed to help control the opioid crisis in America.
In residency, we didn’t think about consequences. We didn’t even realize the consequences. And like a lot of dentists in our country, we didn’t think we belonged in a conversation about the opioid crisis. That’s a physician problem.
And then I saw a stat that said dentists prescribe 12 percent of America’s instant release opioids. Only second to family physicians, who prescribe 15 percent.
And then I joined Neighborcare Health, who makes it their duty to help limit the amount of pills floating around Seattle. And so we greatly restrict our prescribing protocol.
And then four months ago, I found my hands pressing on the sternum of an unconscious woman as I gave her CPR while her 8-year-old son watched in tears from the corner of the room, only minutes after finding his pale blue mother on the couch and yelling for someone to help.
And as the paramedics arrived and assessed her, I heard one of them ask for “Narcan” just before escorting me out of the room.
It’s a reversal agent for opioid overdose. And so only a few minutes kept this family of three from becoming a family of two.
It doesn’t take extremes like this to prove that opioid use and abuse is a real problem that affects our world every day. We can help. And we should help. How?
By caring enough not to over-prescribe. Avoid prescribing opioids to patients you haven’t treated. Never prescribe opioids without talking to a patient about what to do with the unused pills.
Don’t start with opioids, end there. There’s plenty of literature to suggest that ibuprofen and other NSAIDs are just as effective in post-extraction pain management. I always start with NSAIDs and then manage breakthrough pain with opioids on a limited basis. And nine times out of 10, ibuprofen proves to be enough.
At the end of the day, the decision is up to you, the doctor. But with those three letters after your name comes a lot of responsibility… Will you own it?
Just the other day a patient presented to me for extractions. I had already extracted four teeth on him and had prescribed ibuprofen each time. Up to this point, he had never returned after extraction asking for more meds. The ibuprofen was enough.
On this day, however, he told me that he went to the ER over the weekend, was seen by a dental resident, and had a tooth removed. Out of curiosity, I asked him what type of pain meds they gave him.
“Percocet…24 of them.”
As tough as it is to admit, sometimes we are part of the problem. And so today, I ask for the help of all the New Dentists out there. To show your patients compassion, not by prescribing more, but by prescribing smart.
For more information on the topic, visit ADA.org/opioids and read the following resources:
1. ADA Statement on the Use of Opioids in the Treatment of Dental Pain
2. Prevention of prescription opioid abuse: The role of the dentist
Dr. Joe Vaughn is a New Dentist Now guest blogger and a member of the American Dental Association. He grew up in Alabama and recently graduated from The University of Alabama at Birmingham School of Dentistry in 2015. He now lives in Seattle, Washington, and works at Neighborcare Health, a community health center in Seattle. Two cups of coffee, writing and indie music are everyday occurrences for Joe. Go Seahawks and Roll Tide!
Members, to join the discussion surrounding opioids in Washington, consider attending the Opioid Prescribing in Dentistry Summit on Thursday, March 9 from 9:00-11:30 a.m. at the Washington State Department of Labor & Industries Tukwila office. Learn more.