The American Dental Association its members to reduce the number of opioid painkillers they are prescribing. The Association announced a new policy stating that members should “essentially eliminate” opioids from the list of remedies they have at their disposal, “if at all possible.” Weekly Limits for Narcotics The Association also wants to have a time limit put in place on prescriptions of no more than one week at a time. Under the new policy, dentists would be required to complete a mandatory education program that encourages use of other pain relievers. Dentists Prescribe Most Opioids to US Teens Dental practitioners are the leading source of opioid prescriptions for US teens, even though they write less than seven percent of opioid prescriptions in the US. During the period from 2010-2015, the most notable increase in dental prescriptions was for patients aged 11-18. The rate jumped from close to 100 per 1,000 patients to 165 per 1,000 patients. Among all age groups, the rate increased from 131 per 1,000 patients to 147 per 1,000 patients. Other Options Shown to be Just as Effective The number of opioid prescriptions written by dentists continues to rise even though evidence has shown that ibuprofen and acetaminophen control most dental pain effectively, according to an analysis conducted on five studies. The results were published in the Journal of the American Dental Association. These over-the-counter medications are less risky than opioids, which are addictive. When dentists prescribe opioids, they tend to prescribe Vicodin or Percocet to relieve the short-term pain from procedures such as wisdom teeth extractions, dental implants and root canal work. Dr. Paul Moore, Professor at the University of Pittsburgh’s School of Dentistry and the co-author of the analysis, said that the fact dentists are still prescribing opioids when other options are just as effective most of the time is “a little disturbing.” The Association’s new policy supports requiring dentists to complete continuing education courses on limiting opioid use to retain their license. A number of states have already adopted this policy.
With tens of thousands of deaths attributed to prescription painkillers just in the past few years, it is little wonder why policy makers and healthcare professionals are seeking every avenue possible to help save more lives now in the face of this epidemic. The Food and Drug Administration (FDA) recently held a meeting regarding the risk evaluation of extended-release and long-acting opioids. One of the topics of discussion was whether or not all physicians should be required to have specific training on narcotic pain medication to help prevent over-prescribing scenarios. The FDA panel concluded that they should receive such training in order to receive their prescriber number from the Drug Enforcement Administration (DEA). Although the American Medical Association (AMA) has developed their own task force regarding preventing opioid abuse, they are generally opposed to the mandatory training, stating that some doctors don't prescribe painkillers at all and therefore shouldn't be subjected to it. However, the advisory committee for the FDA saw things differently. There is an acknowledgment that over-prescribing of painkillers has been one component to the opioid crisis we face, but previous efforts to provide continuing education to physicians fell short of expectations. Therefore, the advisory committee approved the measure unanimously, and also made additional recommendations, such as mandatory education for patients receiving prescription narcotics. In order to implement the mandates, legislative action will now have to be taken to follow through with the recommendations of the FDA panel. Hopefully the action can be quickly addressed within the House and the Senate. It is possible that the move may take the form of an amendment to the Comprehensive Addiction and Recovery Act (CARA).
Researchers at New York University reported that about 75% of high school heroin users started off using prescription painkillers first. The fact that so many children have access to prescription opioids illustrates the need for more effective policies regarding the availability of these drugs, as over prescribing continues to be a problem. While there have been some changes over the years when it comes to prescribing practices of opiates, the drugs are still easy for people of all ages to obtain. This is likely due to the fact that many doctors are still in the dark when it comes to being able to spot signs of addiction and many people are able to sell their prescriptions for much more on the street. It is also known that students often get prescription drugs by taking them from another family member or getting them from a classmate who has done so. Just like heroin, prescription painkillers are extremely addictive. For some people, it may only take one week of continued use of opiates to become dependent on them. They start to experience withdrawal effects if they stop taking them, and eventually their tolerance builds, requiring them to take more just to achieve the same effect. Abstaining from prescription pills is equally as hard as it is to quit heroin. Withdrawal symptoms from both types of drugs are intense and long lasting. When the pills become too hard to find or afford, addicts often move to heroin because it is cheaper and easier to obtain. The University sent out a release regarding the study, which appeared in the journal Drug and Alcohol Dependence. “As frequency of lifetime opioid use increased, so too did the odds for reporting heroin use, with over three-quarters of heroin users reporting lifetime nonmedical opioid use. More frequent and more recent nonmedical opioid use was associated with increased odds for reporting heroin use,” explained Dr. Joseph J. Palamar, an associate professor at NYU Langone Medical Center. To emphasize the danger of heroin and prescription painkiller abuse, the public was also warned that heroin overdose deaths had almost tripled since 2010. Deaths from prescription painkillers have also quadrupled since 1999. In addition to getting a wrangle on the prescribing practices of these drugs, it is also clear that much more effort be placed behind providing effective education and prevention programs.
Several years ago our culture did not rely as heavily on prescription narcotics to manage chronic pain. In fact, if someone suffered from even moderate pain, many doctors sought other ways to address the problems and only resorted to painkillers if lesser treatments didn't work. This all changed when the pharmaceutical companies developed drugs like Oxycontin. Sales representatives visited doctors and assured them that prescribing painkillers was the more humane option to deal with chronic pain issues. Doctors were encouraged to write more prescriptions for opioid narcotics, and soon millions more people were abusing the drugs. According to multiple lawsuits, the threat of addiction was severely downplayed by the pharmaceutical companies. The more recent trend towards prescribing more narcotic painkillers changed society in that people had access to these drugs like they never had before. These opiates are very similar to heroin, in that they provide the same euphoric feeling, they interact with the brain in the same way heroin does and they have similar withdrawal symptoms. Perhaps physicians would not have been so quick to write so many prescriptions had they known what kind of epidemic would begin. The DEA has set up their own physician training system that some say should be mandatory for all doctors. Prescription drug abuse continues to invade towns throughout the country. In fact, almost 15,000 people die every year from prescription drug overdoses. In addition to the increased efforts to remove excess prescription drugs from the street through take back efforts, educating physicians on better prescribing practices would be a good idea along with holding pharmaceutical companies responsible for deceptive sales techniques. While it is important to help those who are suffering from chronic problems and provide them with the best quality of life, there is also a responsibility to the community. Reducing the number of prescription drugs on the street is one way, without of course denying the medications for those who truly need them. Saving lives and preventing addiction are the goals.