2018-05 advancing short-term prescribing for …...2018/05/19  · advancing short-term prescribing...

AdvancingShort-TermPrescribingforDentalPatients

Understand…1. Prescribingpatternsforacutedentalpain2. Evidence-basedrecommendationsfor

dentalprescribing3. Oregonprescribingguidelinesfordentists4. Initiativestoreducedentalopioid

prescribing

GaryW.Allen,DMD,MSVicePresidentofDentalServicesAdvantageDentalgarya@advantagedental.com

GaryW.Allen,DMD,MS

Ihavenothingtodiscloserelevanttothisdiscussion

OpioidPrescriptionsbyAgeandPhysicianSpecialty

JAMA2011,CharacteristicsofOpioidPrescriptionsin2009

DentistOpioidPrescribingPractices

• 85%oralsurgeonsalmostalwaysprescribeopioidanalgesics

• AverageRx=20tabsprnpain(range10– 40)• 24%prescribemorethanwouldgenerallybenecessary

JournalofOralandMaxillofacialSurgery,September2013

• 2010SurveyWestVirginiadentists:36%expecttheirpatientstohaveleftoverdrugs

JADA 2011,Preventionofprescriptionopioidabuse:Theroleofthedentist

Unusedopioidanalgesicsanddrugdisposalfollowingoutpatientdentalsurgery:Arandomizedcontrolledtrial

• 79patientshadwisdomteethremoved• 94%receivedopioidprescription• Averageprescription=28opioidpills• After24hrs painscale=5• After2dayspainscale=3• After3weeks,averagepillsremaining=15• ExtrapolatetoU.S.population:100millionunusedopioidpills

UniversityofPennsylvaniaPerelmanSchoolofMedicineDrugandAlcoholDependence,Sep16,2016

Providinginformationaboutdrugdisposalprogramsledto22percentincreaseinnumberofpatientswhodisposedofunusedmedication

• Establishedprescribingbehaviors• Prescribingforthemostsevereoutcome

• Patientexpectationsanddemands• UnawareordisregardoftheevidenceforNSAID/APAPincombination

JADA147(7)July2016

InitiativestoReduceOpioidAbuse

• OregonHealthAuthority&CCOs– Develop&communicateguidelines– Opioidprescribingreports&monitoring

• National&StatePolicies&Legislatures– Prescribinglimits– PDMPregistration(OregonHB4143)

• ProfessionalOrganizations

OregonOpioidPrescribingGuidelinesTaskForceDentalSubgroupOct12,2016

CurrentIssueADAadoptsinterimopioidspolicyMarch26,2018

Intheinterimpolicy,theAssociationsaysitsupportsthefollowing:• Mandatorycontinuingeducationonprescribingopioids• Prescribinglimitsonopioiddosageanddurationofnomore

thansevendaysforthetreatmentofacutepain• Dentistsregisteringwithandutilizingprescriptiondrug

monitoringprograms

• ProvidersshouldprescribeNSAIDsasfirst-lineanalgesictherapy• Whenindicatedforacutebreakthroughpain,considershort-actingopioidanalgesics

(startwithlowesteffectivedoseandtheshortestduration)• Ifsuspicionofpatientdrugmisuse,theOMSshouldaccessthePDMP• Limittheprescriptionsofopioidanalgesicstopatientstakingbenzodiazepinesand/or

otheropioids

2017WhitePaper

Modern HealthcareTheleaderinhealthcarebusinessnews,research&data

Aetnatargetsdentist'superprescribers'inlatestopioidinitiativeByShelbyLivingston | May18,2017

Usingclaimsdata,Aetnapinpointeddentistsandoralsurgeonswhoprescribedagreaterthanseven-daysupplyofopioidsatleastfourtimesoveratwo-yearperiod.Earlierthisyear,Aetnasentpersonalletterstothe480dentistsand249oralandmaxillofacialsurgeonswhofitthebillandwarnedthemtheyareinthetop1%ofhighopioidprescribersamongtheirpeers.Aetnaalsosentprescribingguidelinestohelpthose"superprescribers"rightthecourse.

LawLimitingOpioidPrescriptionsSignedinWestVirginiaWestVirginia'sgovernorhassignedlegislationtolimitpainkillerprescriptionsthatdoctorscanprescribeforacutepain.March28,2018,at8:37a.m.

Themeasurehaseventightercontrolsforopioidprescriptionsissuedatemergencyroomsandurgentcarefacilities— afour-daysupply.

ü Dentistsandoptometristswillberestrictedtoprescribingathree-daysupplyofpainpills.

BestDrugsforDentalPainForgetaboutVicodin,Percocet,andotherpotentiallydangerous,addictiveopioids.Over-the-counterpainkillersmayworkbetter.ByTeresaCarrJanuary24,2017

Tofindanauthorizedmedicationtake-backprogramnearyou,gotoDisposeMyMeds.orgorDEAdiversion.usdoj.gov andsearchfor"drugdisposal.”OrcalltheDEA’sRegistrationCallCenterat800-882-9539.

Health Care

Countless Opioid Pills Unused by Dental-Surgery Patients Sept. 27, 2016

CurrentIssueNovember30,2017

Dentiststressesprescribereducation,sharespersonalstoryduringSenateopioidshearing

Accidentalactivist:lifechangesleaddentisttospeakonopioidharmsMarch26,2018