Course helps dentists respond to opioid abuse epidemic

Deaths and hospitalizations caused by opioid overdoses are making U.S. news headlines daily. "Colorado's opioid abuse problem draws state lawmakers' attention" reads a March 22, 2017, Denver Post headline. A March 12 Washington Post headline proclaims "As opioid overdoses rise, police officers become counselors, doctors and social workers" while another headline announces New York City Mayor Bill Blasio's plan to spend $38 million annually to curb opioid addiction and overdoses.

The statistics and individual stories contained in these reports almost always involve incidents of opioid prescribing because the data show that prescription opioids account for nearly half of all opioid overdose deaths in the U.S. today. This amounts to more than 15,000 deaths from overdoses of prescription opioids in 2015, according to Centers for Disease Control.

In California, deaths and hospitalizations from overdose of prescription opioids have leveled off somewhat since 2009, but they remain high. Prescription opioids were involved in the deaths of 2,024 people in 2014, according to California Department of Public Health data. This means California ranks second, after Ohio, in number of opioid-overdose deaths annually in the U.S. Furthermore, some California counties, such as Humboldt, Lake, Lassen and Plumas, have considerably higher overdose rates than the statewide average. And visits to emergency departments for opioid-related poisoning continue to rise, with more than 11,500 visits in 2014, an increase of 103 percent over 2006. The majority of these visits involved prescription opioids.

Drug diversion programs, CURES 2.0 requirements and 'red flags'

Dentists prescribe approximately 11 percent of prescription opioids annually in the U.S. With this in mind, CDA Public Affairs is sponsoring a course, to be held at CDA Presents The Art and Science of Dentistry in Anaheim, that will help dental professionals understand the ever-growing problem of prescription drug abuse and dentists' role in drug diversion programs, including the use of California's prescription drug monitoring program known as CURES, Controlled Substance Utilization Review and Evaluation System. All California prescribers with U.S. Drug and Enforcement Administration registrations were required to register for CURES 2.0 by July 1, 2016.

Specifically, prescribing dentists will learn how to develop a safe and effective regimen for acute pain control for the dental patient as well as how to register for and utilize CURES and recognize "red flag" indicators for prescriptions that have been issued for reasons other than legitimate medical purposes.

"It is every prescriber's responsibility to prescribe opioids in a safe and responsible way," says Michael Bundy, PharmD, DMD, MD, who, along with Tony J. Park, PharmD, JD, is leading the CDA Presents lecture. "Prescription opioid abuse is a national epidemic and a major problem for the health care system as well as law enforcement. Dentists need to be aware of how they can help to get this problem under control."

Park says that the first step of responsible prescribing is to review the patient's medical history, which includes any history of illegal and prescription drug abuse.

As CURES 2.0 aids prescribers and dispensers in identifying the fraudulent or drug-seeking activity of patients, dentists are strongly encouraged to consult CURES when considering prescribing a controlled substance for a new patient or a patient suspected of drug dependency. Under a new law, prescribers will soon be required to check a patient's prescription history in CURES 2.0 prior to prescribing a Schedule II-IV substance in certain situations, with some exemptions.

Course attendees will receive step-by-step instructions for accessing CURES 2.0 along with a review of legitimate medical purposes and many examples of what to watch out for — red flags for drug-seeking behaviors. Dentists will see a sample "patient/client activity" page from the CURES database and hear a patient scenario. With the scenario are questions prescribers should ask themselves or even the patient. The scenario, Park says, becomes a discussion item for attendees: "What should you do?" and "What must you do?"

Options for non-opioid pain control

"Non-steroidal anti-inflammatory drugs, or NSAIDs, such as Ibuprofen, should be first-line therapy for acute pain control in dentistry," says Bundy, who works in the maxillofacial surgery department at Kaiser Permanente Los Angeles. As part of their discussion on how to develop an effective plan for acute pain control, Bundy and Park will teach dentists how to optimize the use of non-narcotics.

"The effectiveness of NSAIDs is often underestimated," Bundy says, noting that several studies show the usefulness of NSAIDs alone, or in combination with other non-opioid medications, in controlling pain.

In "Changing Paradigms for Acute Dental Pain: Prevention Is Better Than PRN," published in the November 2015 issue of the Journal of the California Dental Association, authors Raymond A. Dionne, DDS, PhD, and Sharon M. Gordon, DDS, MPH, PhD, cite studies showing that NSAIDs administered for acute pain are both more effective and have greater safety than acetaminophens or acetaminophen-opioid combinations. "Most acute dental pain is inflammatory in origin and NSAIDs are extremely effective for inhibiting inflammatory pathways, while opioids are devoid of anti-inflammatory activity and cause significant morbidity," they say, adding that "well-controlled clinical trials indicate that the routine use of opioid-acetaminophen combinations rather than NSAIDs for dental pain is neither evidence based nor a logical clinical practice."

Bundy says in closing, "We all should take this national problem personally because we can all help to fix it."

"Clinical and Legal Considerations for Prescribing Controlled Substances" takes place Friday, May 5, from 12:30 to 3 p.m. and offers 2.5 core C.E. units. The course is open to the entire dental team but is open to attendees on a first-come, first-served basis. The course will be audio recorded and made available for purchase after the convention for those who are unable to attend. It will be repeated at CDA Presents in San Francisco this August.

Learn more about the course via the CDA mobile app or at cdapresents.com/anaheim2017. Find CDA's new CURES and opioid resource guide in the "Regulatory Compliance" section on the CDA Practice Support page.

Related Items

CDA has created a new online resource guide to help dentists meet requirements and follow best practices when prescribing opioids for the treatment of patients' dental pain. This resource is CDA's latest in ongoing efforts to address and combat California's opioid epidemic and ensure members have the most up-to-date information to maintain compliance in the dental practice.

CURES 1.0 will be discontinued on Sunday, March 5, 2017. The departments of Consumer Affairs and Justice have announced that beginning March 6 prescribing health care practitioners will only be able to access CURES 2.0. To securely access CURES 2.0, dentists will need to update their web browsers as specified.