pain and opioids12 fewer dental patients receiving opioids limits after root canals, wisdom teeth...
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Pain and Opioids
BRET HAAKE MD, MBA
2/22/19
Handi Medical Supply
Annual Education and Equipment Conference
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What Are Opioids
• Derived from opium poppy or chemically work the same:– Heroin– Fentanyl– Codeine – Vicodin/hydrocodone– Percocet/oxycodone– Dilaudid/hydromorphone– Methadone– Ultram/tramadol– Morphine
What do they do
• Block pain
• Mimic naturally occurring compounds (endorphins and enkephalins)
• Decrease both physical and psychic pain
• Disconnects a person from things that are disturbing
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Appropriate Use of Opiates?
• End of life
• Significant tissue injury
• Major surgeries
• “Handful of very painful conditions”
• Opioid addiction
Prescription Opioid Epidemic
15 million people on prescription opiates
7,500,000 recreational users
600,000 ER visits per year
150,000 admitted to hospitals
20,000 death each year
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Opioid Addiction and the First Dose
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Aggressive Marketing
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Additional Facts
• 80% of all heroin users were introduced to opiates through prescription medications
• People who use prescription opioids are 40x more likely to use heroin
• Risk of opioid habituation after opioid use:Risk of Being on Opiates One Year Later
Single prescription 7.5%
Second prescription 15%
“30 days of opiate medications” 30%
CDC: MMWR Weekly / March 17, 2017 / 66(10);265–269
What happens with opioids after surgery?
• 83% reported taking half or less
• Leftover opioids were stored in an unlocked location in 77% of patients
PLoS One. 2016 Jan 29;11(1):e0147972. doi: 10.1371/journal.pone.0147972.
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How to Treat Pain Differently: “7 Years of Neck Pain”
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What makes pain better
ExerciseReassurance & Education
Minimizing medications
Medication Efficacy in Dental Pain
JADA 149(4) n http://jada.ada.org n April 2018
Medication efficacy in dental pain
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MRI Changes Without Pain
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What are we doing?
• Specialized pain clinics
• Standards of care
• Increasing availability of addiction treatments
• Pain treatment with minimal opioids
• Collaborating statewide and nationally
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30% reduction in opioids prescribed
‐
200,000
400,000
600,000
800,000
1,000,000
1,200,000
1,400,000
1,600,000
Jan‐16 Apr‐16 Jul‐16 Oct‐16 Jan‐17 Apr‐17 Jul‐17 Oct‐17 Jan‐18
890K pills
1.2M pills -30%in two years
-3.4MDecrease in annual opioid pills prescribed
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Fewer dental patients receiving opioids
Limits after root canals, wisdom teeth removal and other dental work
Still effectively managing pain
-91,500decrease in opioid pills in one year
Fewer low back pain patients receiving opioids
2,300fewer patients
received opioids for acute low back pain in first six weeks
51%fewer patients
received opioids after being diagnosed with chronic back pain
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Reducing opioids through our health plan
Program to prevent multiple prescriptions
Review high‐prescribing clinicians
Limits on morphine equivalent dose of 90 mg per day
-2.5Mdecrease in opioid pills in one year
QUESTIONS?