Research examines dentists’ role in painkiller abuse

In the cover article of this month’s Journal of the American Dental Association, a group of nine dentists, pharmacists, and addiction experts provides new research and recommendations to help dentists combat, rather than contribute to, abuse of addictive painkillers.

The Obama administration turned a bright spotlight on prescription painkiller abuse in April when the Office of National Drug Control Policy released a national action plan and a statement from Vice President Joe Biden. With a cover article in the July edition of the Journal of the American Dental Association (JADA), dentists focus that spotlight on themselves both as major sources of opioid drugs and as professionals with largely untapped power to recognize and reduce abuse.

“Many dentists really haven’t even perceived there to be a problem,” said George Kenna, an assistant professor of psychiatry and human behavior at the Warren Alpert Medical School of Brown University, an addiction psychologist at the Center for Alcohol and Addiction Studies, and the corresponding author of the article. “Dentists write the third-most prescriptions for immediate release opioids in the United States, but they often don’t know the appropriate number of doses to prescribe, how many doses a patient uses, or most importantly what patients do with the leftover tablets they have. Just ask someone the last time they threw away opioid prescriptions in particular. These leftover tablets - accumulated from various sources, not just dentists — that are often left in closets across the country are the primary source for prescription drug use initiation for children and adolescents.”

As outlined by the administration’s policy, facilitating ways to reduce the number of leftover painkillers such as hydrocodone and oxycodone that can become a supply of drugs in the home for those who would abuse them, dentists and other prescribers would be taking a significant step, said Kenna who is also a pharmacist. The National Survey on Drug Use and Health has found that seven in 10 people who have used painkillers nonmedically got the drugs through a family member or friend who had a prescription.

Last year Kenna helped lead a meeting of dentists and fellow addiction experts and pharmacists at the Tufts Health Care Institute Program on Opioid Risk Management, where he serves as a scientific adviser. The group produced this month’s cover article for JADA, which offered several recommendations for dentists, including:

* Discuss with patients whether they need an opioid for their pain and how likely they are to use what you prescribe.
* Consider writing small quantities and limit refills.
* Do not prescribe drugs to patients you do not know; be suspicious of those who claim their drugs were lost or stolen.
* Use prescription monitoring programs (i.e., state databases), if available, to verify drug-use history.
* Advise patients either to destroy or lockup any excess medication.* Keep prescription pads locked up.