New opioid policy furthers CDA's efforts to reduce abuse, misuse

Providing education, promoting evidence-based acute pain management practices and forming partnerships with specialty dental organizations form the basis of the CDA Opioid Policy adopted by the CDA House of Delegates at its annual meeting last November.

The new policy, effective now, solidifies CDA’s role as a leader in state health care policy and creates new opportunities to collaborate with the public, policymakers and health care colleagues to reduce the misuse and abuse of prescription opioids. In California in 2016, the most recent year for which complete data are available, 45 opioid prescriptions were dispensed for every 100 residents and nearly 2,000 people died from opioid overdoses. Another 4,000 were hospitalized or visited the emergency room due to opioid overdoses.

The policy adds to the activities CDA has led since 2014 to combat the national opioid crisis, including offering a course on the pharmacologic and regulatory concerns of opioid prescribing at the association’s biannual continuing education convention; publishing articles and regular updates about California’s prescription drug monitoring program known as CURES 2.0 and making this information easily accessible to dentists on CDA’s website; hosting a webinar on CURES 2.0 registration; and supporting several pieces of legislation that address prescribing and data sharing. More recently, CDA produced a first-ever special edition of the Update in September 2018 that focused on prescription opioids in dentistry.

“CDA will promote the use of prescription drug monitoring programs, substance use disorder education, and enhanced collaboration between dentists and their medical colleagues to assist in identifying a patient’s full medication profile and potential substance use disorders prior to prescribing an opioid,” the opioid policy states.

C.E., addiction risk discussed at CDA House of Delegates

In a panel discussion on opioids at the CDA House of Delegates last November, Tom Stewart, DDS, president of the Dental Board of California, spoke about the board’s process for developing a mandatory course on the “risks of addiction associated with the use of Schedule II drugs” as authorized by Senate Bill 1109. CDA and the dental board supported the bill, which was signed into state law last fall.

Dr. Stewart shared that the board’s Substance Abuse Awareness Committee has begun to consider the course’s content, how many units it would offer and whether the course would be a one-time or ongoing requirement for each two-year license renewal period. Development of the course criteria will continue through 2019, with any new regulation likely to take effect in 12 to 18 months.

Another panelist, Ronni Brown, DDS, MPH, discussed addiction as a complex disease process as well as dentistry’s role in both creating and preventing it. Dr. Brown drew from her substantial research on the effects of drug-use patterns on the severity of “meth mouth” and her 20-plus years treating patients with the condition.

Brown emphasized in her speech the problem of first exposure: The dental profession may be second to primary care physicians in opioid prescribing overall. Yet, she said, “We are the providers of first exposure to a very addictive category of drugs to our young patients.” She recommended new mandated continuing education that trains dentists to be responsible prescribers along with evidence-based prescribing practices that show, for example, the effectiveness of ibuprofen alone or in combination with acetaminophen for reducing duration and intensity of pain.

California Sen. Richard Pan, MD, also sat on the panel and offered a health care provider’s perspective, speaking about the variations individuals experience when it comes to feeling pain and how these variant experiences pose challenges for providers, who must meet each patient’s need while being mindful of addiction concerns. He noted the arc of pain management practices over the last 20 years, as opioids were marketed as the best way to manage pain, without concerns for addiction, and what has happened over time to bring us to the current crisis.

The panel was well-attended and, overall, well-received with attendees naming their main takeaways in comments. They included: “There are other ways of managing pain,” “Prescribing opioids for accurate pain management should be approached with caution,” “More education is needed around the issue among dentists and doctors,” and “This is extremely complex. Item 1: Take care of your patient.”

Find the CDA Opioid Policy at cda.org/opioid. CDA will keep members informed about any new C.E. developed and mandated by the dental board.

Related Items

Many bills were introduced over the past year to combat the opioid epidemic in California, as CDA previously reported. Here is an overview of CDA-supported legislation in the areas of e-prescribing, informed consent, interstate data sharing and prescription-pad requirements, that Gov. Jerry Brown signed into law in September and how these bills will affect the practice of dentistry.

Sometimes you read a research article and it hits you between the eyes like a sledgehammer. So it was when I read “Prescription Opioids in Adolescence and Future Opioid Misuse” published in the journal Pediatrics in 2015. It made me really reconsider the impact dentists can have on ameliorating the opioid crisis.

Opioids in California: What is CDA doing?
By Kerry K. Carney, DDS, CDE
CDA began addressing opioids more than three years ago, but the data and countless personal stories tell us that now is a good time to pull together all our resources and efforts and provide our membership with a 360-degree look at the issue in California and CDA’s leadership on it.