I enjoy writing this column, especially when it can be fun, as well as educational. This time, however, there is no way to put a lighthearted spin on the subject.

Most people are aware of the disheartening problem of opioid addiction in our beautiful state and the rest of the nation. It is a current topic in the media. I feel like it is important to let you know how this epidemic is affecting you and your dentist. Many solutions are being offered, some by the Maine Legislature. As a dentist, I want to be a part of the solution.

First, a few facts to illustrate how critical the opioid addiction situation is in Maine.

Maine leads the nation in per capita prescriptions for long-acting opioids. In 2015, 272 Mainers died from opioid/heroin overdoses. This number increased 40 percent in 2016 when 376 deaths occurred – 313 of which involved opioids, not heroin.

These numbers are higher than annual car fatalities in Maine. There were more opioid/heroin overdose deaths in 2016 than deaths from homicide for the past 10 years in Maine. Also in 2016, one out of every 11 babies born in Maine was drug affected. That means that every day in 2016, three drug affected babies were born in our state.

A quote from the April 21, 2016 New England Journal of Medicine summarized the situation this way: “We know of no other medication routinely used for a nonfatal condition that kills patients so frequently.”

How did we get here?

As is often the case, we believed a story that sounded too good to be true. Because the medical community is sworn to uphold life and minimize pain where possible, we are eager for ways to improve patients’ quality of life. So,when news of a class of effective, safe, long-term pain medications broke in the 1990s, the medical world was ready to believe it.

The too-good-to-be-true story included these three lies: Opioids are more effective than over the counter pain relievers such as ibuprofen and acetaminophen. Opioids have no ceiling dose – in other words – you can take as much as you need – there is no maximum dose. Opioids have a less than 1 percent risk of addiction.

Sad experience and scientific research have proven otherwise.

Our state legislature has acted rapidly to enact measures within the medical/dental community to increase awareness of the problem, educate practitioners on reliable alternatives to opioid pain management, and in making an effort to reduce the number of opioid prescriptions written.

Dentists are a piece of this solution because as members of the medical profession we also believed the too-good-to-be true story and got into the habit of prescribing a few opioids after most surgical procedures. The post-surgical pain was managed with the opioid prescription, but here is the problem: Prescriptions get filled, and there are often left-over tablets that are not needed for the intended pain relief.

To illustrate the magnitude of the left-over pill problem we will consider wisdom teeth. In the U.S., about 10 million wisdom teeth are removed annually in approximately 3.5 million surgeries. On average, 20 tablets of opioid medication are prescribed per surgery for a total of 70 million tablets. Statistically, only eight of those tablets are used by the patient for post-operative pain control. That leaves 42 MILLION opioid tablets vulnerable to misuse and abuse.

And that is just the wisdom tooth piece of the puzzle!

The good news is, we as dentists and patients can be a lot smarter and safer. Quality research has determined that opioids are NOT more effective in controlling pain than over-the-counter pain medications. This information is penetrating the dental practice world rapidly and is reducing the number and size of opioid prescriptions written by dentists.

When I was exposed to this research almost two years ago, I immediately stopped writing opioid prescriptions. I now give over-the-counter medication prior to the surgical procedure and give very specific instructions for the use of over-the-counter pain medications for post-surgical pain control.

As many dentists do, I call my surgical patients to follow up on their progress. What I have learned from these follow-up conversations is that patients are doing just as well with the new protocol of over-the-counter pain medication.

I have written exactly one opioid prescription in the last two years. In the past, I may have written 100 opioid prescriptions in a two-year period.

The Maine State Legislature has enacted laws to limit access to opioid prescriptions. In the past, a dentist or physician could prescribe opioids by using a prescription pad and simply writing down the necessary information. Now, a dentist needs to look up every patient prescription history, if an opioid or benzodiazepine prescription is required.

The website providing the history is the Prescription Monitoring Program website. This website provides information about who else has prescribed for the patient, where and when the patient has filled prescriptions and how the prescriptions were paid for. Obviously, this information gives the prescriber a good idea of the patient’s pattern of use and whether or not an additional prescription is warranted.

The other hurdle that prescribers must clear is the requirement that all opioid prescriptions must be transmitted electronically to the pharmacy. This is a costly and time-consuming process for dentists as there are annual or monthly fees for the software required to send these prescriptions electronically. As a result of these challenges, many general dentists are choosing not to prescribe opioids. In our office, in the rare event that an opioid prescription is needed, we coordinate with the patient’s physician to prescribe the medication.

The new law has an insightful provision that all patients filling an opioid prescription should be aware of. For example, if a prescription is for 10 tablets, and the patient knows that they will probably only use five, they can request the pharmacist to fill the prescription only for the five tablets. If this is done, the balance of the prescription is void. If additional tablets are needed, the patient must contact the prescriber for a second prescription.

Efforts to curb opioid abuse in Maine appear to be meeting with some early successes. For example, the number of opioid prescriptions filled in Maine decreased 21.5 percent from 2013 to 2016. The national average reduction for the same period was 14.6 percent. While year-end statistics are not yet available, midyear statistics on overdose deaths in Maine indicate that the 40 percent increase in opioid-related deaths has been stopped.

There is something you can do to help, as well. Please do not come to your dental appointments and request opioid pain relief. You can expect that your dentist will be very reluctant to give you an opioid prescription if you do ask. Additionally, some general dentists will not be able to legally prescribe opioids for you because they have not met the electronic prescribing requirement.

What you should expect from your general dentist is quality pain management with over-the-counter medications taken according to specific protocols. You can also expect, or request, an analgesic prior to your procedure.
In the rare event that an opioid is required, if your general dentist does not prescribe opioids, they can help you coordinate with your physician to obtain them. We each have an opportunity to be part of the solution, let’s work together!

Polly Nichols, DDS., practices dentistry at Topsham Dental Arts along with her brother, Gregory Sprague, D.D.S., and her father, J. Howard Sprague, D.D.S. Topsham Dental Arts is located at 37 Foreside Road. For more information, call 798-6700 or visit topshamdentalarts.com.

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