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Dentists moving away from opioid prescriptions

Study find 45 percent of youth prescriptions come from dentists

MICHAEL KELLY The Marietta Times Dr. Peter Lovejoy talks with Patricia Coley, an expanded functions dental assistant, in a supply area at Family Tree Dental on Acme Street in Marietta on Wednesday. Dentists, like doctors, have become increasingly cautious about prescribing opioids for their patients.

The vulnerability of the adolescent brain to unhealthy influences is well-known by parents and teachers, but new medical research has suggested young people can be particularly susceptible to the neurochemical changes characteristic of opioid use disorder.

Dentists are a small segment of opioid prescribers who generally deal with short-term, acute pain, but they write about 45 percent of the opioid prescriptions for adolescents and young adults, according to information recently compiled by insurance giant United Healthcare. The company this month undertook a campaign to make its customers and the general public, particularly parents and teens, aware of the hazards of even short-term opioid use among young people.

“Our data indicates that about 12 percent of all opioid prescriptions are by dentists, and also about 45 percent of the prescriptions written for teens are by dentists,” Dr. Ted Wong, the company’s chief dental officer, said in an interview Wednesday. “The simple explanation is that dentists remove about five million wisdom teeth a year.”

The vast majority of wisdom tooth extraction procedures are done on young people.

“About two-thirds of those patients would receive an opioid prescription, and research has found that young people are more susceptible, more likely to abuse them, so we’re working with the dental professionals in our plan to reduce that, but awareness on the part of parents and adolescents is also key to reducing that,” Wong said.

Wong said the opioid crisis, coupled with recent research into alternative pain medication and adverse publicity about opioid use, has had the effect of reducing dental opioid prescriptions by about 17 percent in recent years.

That is not to say, however, that dentists aren’t dealing with their patients’ pain.

Marietta dentist Dr. Peter Lovejoy, who has been practicing for about 10 years at Family Tree Dental, said over-the-counter combinations of anti-inflammatory medicines have been shown to be at least as effective as opioids such as hydrocodone or codeine if they’re taken in accordance with the dentist’s directions.

“Research has shown that a combination of Advil and Tylenol (ibuprofin and acetominophen) is very effective,” Lovejoy said. “We stress with our patients to be proactive about following the directions in taking it – don’t wait for the pain to start, set an alarm if you need to, but take it on schedule.”

Opioids are effective pain management drugs, he said, but they are most effective as a supplement to anti-inflammatories, and best avoided if possible.

“Some patients are a little hesitant, and no doctor wants a patient to be in pain, but with the reality of opioid addiction, if we can do without them, we’d prefer that, but they still have a place in modern medicine,” he said. “We’ve found that anti-inflammatories like Advil and Tylenol are just as effective without the side effects of making you woozy or exposing you to the danger of addiction.”

Dr. John Frye, another Marietta dentist, said the dangers associated with opioids are rarely worth the risk, particularly when better pain reduction options are available.

“The biggest reason is that opioids are just not good at true pain management. Ibuprofin is a far better pain mitigation tool,” said Frye, who has been practicing about 13 years. “Every once in a while you get someone for whom it works well. Back in the heyday of Vicodin (a hydrocodone-acetaminophen opioid compound) it was not unusual for doctors to prescribe 150 pills at a time. For me to prescribe 25 or 30 would be a very unusual set of circumstances.”

Frye also noted that recent state regulations directed toward reducing opioid prescribing has placed seven-day limits on prescriptions and requires reporting to the state pharmacology board.

“There are a lot of regulatory things that make prescribing more difficult,” he said.

United Healthcare has placed a three-day limit on opioids prescribed by its network of dental providers, Wong said.

Wong also urged parents and young patients to discuss pain management strategies with their dentists and not to be afraid to ask questions.

“We’re trying to communicate to parents that there are things they can do to reduce or eliminate the use of opioids. The first thing to keep in mind is, don’t be afraid to have the discussion with your dentist,” he said. “If you express concern, the dentist will be more likely to reduce or eliminate them. And take them only if needed – you don’t have to take them at all if you don’t feel the need to – and manage any leftover medication. Fifty percent of all these prescriptions are never used, but don’t just throw them away.”

Pharmacies will take returned drugs, or they can be turned over to law enforcement agencies or the Drug Enforcement Administration, he said. Pharmacies also offer disposal bottles that render the opioids ineffective, or the pills can be dissolved in water and combined with coffee grounds or cat litter, sealed in a bag and thrown out, he said.

More information is available from the National Institutes of Health website or the United Healthcare newsroom:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2886920/

newsroom.uhc.com

Opioids and dentistry

•Percentage of opioid prescriptions written by dentists: 17 percent.

•Percentage written by dentists for adolescents: 45 percent.

•Number of wisdom tooth extraction procedures done annually in the U.S.: About 5 million (all ages, but most are 16-22).

•Percentage of wisdom tooth extraction patients who get opioid prescriptions: 70 percent.

Source: United Healthcare.

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