The opioid crisis has had a well-documented impact across the country, and our neighborhoods in Chautauqua County have not been spared. According to New York State Department of Health’s 2017 Opioid Annual report, the county rates for opioid overdoses and deaths rank considerably higher than state averages.
We have seen friends, families and colleagues affected. One young man who performed electrical work for me during construction of both my office and home died of a narcotic overdose several years ago. It has left a lasting impression.
People can and have become addicted to opioids after receiving a medically prescribed prescription for pain medication. We, as dentists, can minimize our contribution to the problem by changing our prescribing practices.
The American Dental Association recently announced a new policy supporting mandates on prescription limits and continuing education in prescribing opioids and other controlled substances.
One of the ADA policies, supporting dentists registering and utilizing a Prescription Drug Monitoring Program, is already in effect in New York State. This has allowed us to see what other prescribers have given to a patient.
Here are five other ways that we can limit the amount of opioids we prescribe.
- Be Proactive and Pre-empt Pain.
We use pre-emptive pain control where possible. A loading dose of a nonsteroidal pain medication prior to a procedure can be helpful in limiting post-surgical pain. A 600 mg dose of ibuprofen one hour pre-operatively can establish pain control and limit inflammatory mediators prior to the procedure.Keeping the 600 mg dose on a post-op 6-hour clock schedule will prevent the blood levels of the medication from falling and maintain efficacy, reducing the need for narcotic pain medication. Additionally, alternating acetaminophen and ibuprofen allows for different mechanisms of action to achieve more complete pain control. We also break treatment into stages to allow for smaller steps at a single time, minimizing pain response.
- Be Clear: This is Not Pain Free.
We communicate with patients that we want them to be comfortable, but avoid using the words “pain free.” Most patients can tolerate some discomfort and it is safer to have some discomfort rather than be “pain free” as was advocated in the past.
- Ice is Still Effective!
Using ice packs when swelling is anticipated also helps with discomfort.
- Lower Dosages = Less Problems.
Prescribe narcotics in smaller numbers. A refill can always be emailed to a patient’s pharmacy if more pain medication is needed. Using lower strength narcotic prescription medications when possible will help minimize the potential for addiction. We use Exparel, a long-acting depot form of bupivacaine for procedures where incisional pain and surgical site pain can be significant. We use this routinely for third molar sites since this form of pain control lasts for three days and usually allows patients to get past the acute phase of recovery.
- Know the Patient’s History.
Being aware of a patient’s current medication usage and history is vitally important.If there is a history of narcotic abuse and treatment, utilizing the primary care physician as a resource or an addiction specialist for advice is very helpful. Deferring pain management to them is a good strategy and, in some cases, is even restricted to them.
Dr. David W. Todd, DMD, MD, has been active in his profession. He has authored 18 articles in various publications and made numerous presentations at state, regional, and national meetings. For Dr. Todd’s full bio click here.