Dentists are the newest group of clinicians being asked to double down in the effort to fight the opioid epidemic by cutting back on prescriptions.
The American Dental Association announced Monday an interim policy that supports a seven-day limit on prescription drugs for treatment of acute pain.
In addition, the ADA, which represents about 161,000 dentists, supports mandatory continuing education in prescribing narcotics, limits on dosages, and the use of prescription-drug monitoring programs.
The new position puts the group in line with federal guidelines which suggest clinicians prescribe the lowest effective dose of immediate-release pain killers. They also suggest three days of medicine to manage acute pain, but no more than seven days.
Pennsylvania dentists and oral surgeons have been complying with the recommendations for about a year.
"It's the law," said Elliot Hersh, professor of oral surgery and pharmacology at the University of Pennsylvania School of Dental Medicine. Pennsylvania was one of the last states to adopt the requirement that doctors look up a patient's history on the state drug monitoring program before writing a prescription, an effort to detect signs of doctor-shopping for multiple scripts.
Opioids should not be the first line of pain relief, Hersh said. Many patients can be treated with a combination of ibuprofen, like Advil or Motrin, plus acetaminophen or naproxen sodium such as Aleve or Anaprox plus acetaminophen, he said.
About 85 percent to 90 percent of patients who take an opioid will develop undesirable side effects like drowsiness, nausea, and constipation, he added.
However, there are some challenges when it comes to prescribing for pain after dental surgery – like impacted third molars – while the patients are still numb, said Hersh.
"We have no idea precisely what the level of post-operative pain will be," he said. "We often prescribe for the worst-case scenario."
According to the Journal of Preventive Medicine, most of the opioid prescriptions in the United States are written by physicians and other medical professionals, not dentists. In 1998, dentists prescribed 15.5 percent of opioid pain relievers in the U.S. By 2012, that number dropped to 6.4 percent, the journal reported.
The largest increase for opioid prescriptions was among dental patients 11 to 18 years, researchers at the ADA Health Policy Institute found. They reviewed data from about 1.1 million privately insured dental patients from 2010 to 2015. In all age groups in the same time period, prescriptions increased by 17 per 1,000 patients, the data showed.
Hersh said there are generally three types of doctors that overprescribe opioids – the outdated doctors who haven't kept up with changes, the duped doctors who fall victim to patients looking for narcotics, and the dishonest doctors. These doctors are in all fields, not just dentistry, he said.
While there are no hard numbers, agents do not see a lot of pill mills at dentist offices, said Patrick Trainor, a public information officer for the Philadelphia Drug Enforcement Agency.