Alabama is first in the nation in opioid prescriptions per capita, according to the University of Alabama at Birmingham (UAB). It also has seen a 269% increase in overdose deaths in Jefferson County alone. Now, the UAB School of Dentistry is taking steps to combat these figures in the hopes that their efforts will be replicated elsewhere across the country.
“The public health crisis we are dealing with stems from many roots, ranging from easy access to prescription medication and the quantity in which medication is prescribed to the inability of physicians to set realistic expectations with patients about pain,” said Nico Geurs, DDS, chair of UAB’s Department of Periodontology.
“As dentists, we’re facing a watershed time when patients have a list of requests for pain medications that they think they need and expect to receive, none of which are in line with reality,” Geurs continued. “Pain management with opioids has been normalized in American culture, and it’s rapidly spiraling out of control.”
Geurs and Michael S. Reddy, DMD, DMSc, dean of the UAB School of Dentistry, have been selected to serve as representatives on a new opioid council formed by the American Dental Education Association to implement transformative measures into dental education curricula on the student and practitioner levels.
From educating faculty about best practices for writing prescriptions to leading task forces that will revise dental school curricula relating to medication, this council will help lead collaborative task forces that aim to change the trajectory of the opioid epidemic. The council also believes continuing education for practicing dentists will play a role.
The multi-fold approach will involve setting expectations with patients about pain management and treating addiction like the disease it is to see change. If dentists can better understand the causes of supply and demand, the council believes, they have the potential to curb the number of prescriptions that are written and can help influence change.
“A dentist may stress that the procedure won’t be too challenging, setting the expectation to the patient that they won’t experience any pain. Post-surgery, the patient naturally experiences moderate pain for a few days, but perceives that pain to be out of this world due to their thought that no pain would occur,” Geurs said.
“The dentist then prescribes pain medication, typically four pills a day for 10 days, whereas traditional NSAIDs like ibuprofen and acetaminophen could easily have done the job. The patient may take three or four pills, leaving them with nearly 35 extras. The next time that patient experiences any discomfort, they have a lot of medication to turn too. They may share a pill with a friend or family member. The cycle of misuse begins,” Geurs said.
“It’s up to us to acknowledge and prep the patient for the amount of anticipated pain they may experience, but also recognize that pain management is not a one-size-fits-all approach. Even the most seemingly challenging of procedures should warrant only a few days of discomfort, and certainly not an extended amount of pain that calls for a prescription of 40 pills,” said Geurs.
Many practitioners see pain assessment as daunting, and opioids became an accepted solution regardless of size or scope. Now, UAB’s faculty understands that the curriculum needs to go beyond just understanding the pharmacology of drugs and to understanding the roots of pain and key management solutions that will serve in the patient’s best interest.
While estimating expected pain is challenging, Geurs said, practitioners must make educated decisions about who needs opioids and who can take NSAIDs. There is a distinct difference in discomfort and pain, and training dentists to write prescriptions only after thorough re-evaluation with the patient may limit unneeded prescriptions form being filled.
The UAB faculty believes that the first step in prevention is teaching the next generation of dentists proper care before they enter practice. The School of Dentistry is focused on implementing standards that teach students about the disease of addiction, rather than seeing it as a habitual choice. If dentists can recognize and treat signs of addiction from the start, they can avoid making the disease worse and help set the patient on a path to recovery.
“In dentistry, we view the mouth as a mirror to the body. We can diagnose signs of cancer and diabetes. But when we recognize addiction, we aren’t filtering those patients in need to appropriate physicians to get them the care they need. This gap has continued to grow drastically in Alabama, and we as dentists have the ability to play a key role in curbing prescription medication from getting into the wrong hands,” Geurs said.
The School of Dentistry is now evaluating screening tools for addiction risk and action steps to be taken when patients are in need. Geurs hopes this will translate to practicing dentists and provide a strong foundation for continuing education courses that can be accessed across the city and state.
Also, the council believes that collaboration between dental schools and state agencies will be critical in helping to establish baseline standards on prescription patterns, developing a substance abuse program, and garnering practicing dentists to buy into this new model of care. The School of Dentistry sees this as a unique responsibility to serve as leaders and foster fundamental change.
“Closing the loop isn’t easy, and this is new territory for all of us,” Geurs said. “For the School of Dentistry to be in a position where we can help alter the trajectory of this epidemic is one that we take with great responsibility, and we hope public and clinical education will help protect others moving forward.”
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