ADA advances national policy to reduce opioid dependency

The ADA has adopted a new policy to combat the opioid epidemic, calling it the potential first of its kind by a major health professional organization to support mandates on opioid prescription limits and continuing education.

“I call upon dentists everywhere to double down on their efforts to prevent opioids from harming our patients and their families,” said ADA President Joseph P. Crowley, DDS, in a press release.

Issued Monday, March 26, The Interim Board Policy on Opioid Prescribing addresses three components: continuing education, dosage and duration, and prescription and drug monitoring. Specifically, the policy states that the ADA supports:

  • mandatory continuing education in prescribing opioids and other controlled substances;
  • statutory limits on opioid dosage and duration of no more than seven days for the treatment of acute pain, consistent with the Centers for Disease Control and Prevention’s evidence-based guidelines; and
  • dentists’ registration and use of prescription drug monitoring programs (this is CURES 2.0 in California) to promote the appropriate use of opioids and deter misuse and abuse.

The mandatory C.E. would be “tailored to the specific needs of dentists and dental practices,” would emphasize preventing drug overdoses, chemical dependency and diversion and would be acceptable for both Drug Enforcement Agency registration and state dental board requirements. A phase-in period would allow affected dentists time to become compliant.

Although the ADA in its press release notes that the number of opioid prescriptions written by dentists in the U.S. has fallen since 1998, it also states that “there is more work to be done.”

The major studies cited today say dentists write 11 to 12 percent of immediate-release prescription opioids annually in the U.S. Perhaps more critically, oral surgeons write the majority of opioid prescriptions to patients who are in a particularly vulnerable age range: the 10- to 19-year-olds. Opioid overdoses account for more than 1,900 deaths in California in 2016, according to California Department of Public Health data. The ADA cites 42,000 opioid-related deaths nationwide in 2016 — the highest of any year on record — with 40 percent of those involving a prescription pain reliever.

“This new policy demonstrates ADA’s firm commitment to help fight the country’s opioid epidemic while continuing to help patients manage dental pain,” Crowley said.

The policy is accessible on the ADA website. Dentists can also find four feature articles on opioid prescribing from the dental perspective in the April issue of the Journal of the American Dental Association. Additionally, the ADA on April 25 will host the next in its series of online C.E. courses on opioid prescribing. The webinar will “explore how dentists can use their Drug Enforcement Administration prescribing authorities to reduce prescriptions for dental pain.” Registration is open.

California Legislature, CDA Presents lecture, address opioids and CURES

The ADA notes in the press release that more than 130 opioid-related bills have been introduced in U.S. Congress since January of this year. In California alone, more than two dozen bills are working their way through the state Legislature, including several by Assemblymember Jim Wood (D-Healdsburg), DDS. CDA is working with legislators and oral health stakeholders and will take a position on one or more of these bills in the coming weeks with more reporting on cda.org to follow.

Additionally, CDA continues to provide education and resources on opioids and pain management to members and dentists throughout California. In May at CDA Presents The Art and Science of Dentistry in Anaheim, CDA Public Affairs will host “Clinical and Legal Considerations for Prescribing Controlled Substances.” Led by Michael J. Bundy, PharmD, DMD, MD, and Tony J. Park, PharmD, JD, the course will show dentists how to develop a plan for acute pain control for their patients, helping to safely and effectively manage pain while at the same time preventing the overprescribing of narcotic pain medication. The course will also cover the latest legal and regulatory developments with respect to California’s Controlled Substance Utilization Review and Evaluation System known as CURES 2.0.

“From offering courses at CDA’s biannual education convention to communicating CURES 2.0 registration requirements to exploring opioids and pain management in-depth in the CDA Journal, CDA has been at the forefront of educating dentists about the use of opioids to manage patients’ pain,” said CDA President Natasha Lee, DDS.

An article in the April CDA Update provides some background on legislative efforts to curb opioid dependency in California as well as more details about the CDA Presents lecture.

Find resources on opioid pain management and CURES 2.0 registration at cda.org/opioid. Register to attend the CDA Presents course “Clinical and Legal Considerations for Prescribing Controlled Substances” at cdapresents.com/anaheim2018.

Related Items

“All health care practitioners authorized to prescribe or dispense Schedule II-IV controlled substances were required to register to use CURES 2.0 no later than July 1, 2016,” the Dental Board of California reminds dentists in an email distributed late January. California’s Controlled Substance Utilization Review and Evaluation System aids prescribers and dispensers in identifying fraudulent activity and is intended to reduce prescription drug abuse and diversion.

With the U.S. Department of Health and Human Services on Oct. 26 declaring the opioid crisis a public health emergency, CDA reminds dentists, who prescribe approximately 11 percent of prescription opioids annually, of the resources available to them. CDA’s online opioid resource guide at cda.org/opioid is regularly updated with links to resources as they are published.

In California alone, opioid-related deaths from 2002 to 2014 were up almost 30 percent, and dentists prescribe up to 12 percent of all opioid prescriptions in the U.S. In light of these alarming statistics, the Dental Board of California in August 2017 finalized and adopted a policy statement recognizing the epidemic of opioid abuse in the U.S.