It was recently reported that a former Twin Cities dentist agreed to a financial settlement in connection with allegations that he illegally prescribed hundreds of opioid painkillers to numerous patients, as well as his son and an employee. In light of the nation’s ongoing opioid epidemic and the potential legal liabilities facing dental professionals, dentists should consider alternatives for relieving their patients’ pain.
How can dentists help to combat opioid addiction?
In 2018, the American Dental Association, released a policy on combating opioid addiction with the following 3 components:
- Mandatory continuing education for dentists on the prescribing of opioids
- Support of statutory limits on opioid doses and durations
- Utilizing prescription drug monitoring programs to identify patients seeking treatment from multiple practitioners
The ADA also recommends that dentists move away from prescribing opioids as much as possible and provide patients with effective alternatives for pain relief. These alternatives include:
Nasal Sprays
New intranasal nonsteroidal anti-inflammatory drugs (NSAID) provide pain relief equivalent to that of opioids. Nasal sprays are generally indicated for short-term pain management (up to 5 day) for adult patients who require an opioid-level analgesic. In particular, nasal sprays are effective for treating pain due to extractions, root canals, implants, or periodontal surgery. Nasal sprays are not recommended for those with peptic ulcer disease, gastrointestinal bleeding, patients already taking blood thinners or people who may be allergic to NSAIDS.
Long-Lasting Local Anesthetics
Because pain medications have limited duration, patients often experience increased pain before another dose is provided. Today, however, long-lasting anesthetics are available that provide a slow and continual release of pain relief, in some cases up to 96 hours. Long-lasting local anesthetics can also be used in conjunction with nerve blocks and lidocaine, a powerful combination that provides both immediate and long-term pain relief.
Combining Conventional NSAIDS
It has long been known that combining ibuprofen and acetaminophen is an effective pain management therapy. In fact, a 2013 article published by the Journal of the American Dental Association (here) found that such a combination “may be a more effective analgesic, with fewer untoward effects, than are many of the currently available opioid-containing formulations.”
In sum, there are a variety of opioid alternatives available to manage pain which can help to mitigate prevent opioid addiction in patients suffering from acute pain.
Why This Matters
Given the alternative pain therapies available, dentists can and should move away from prescribing opioids as often as possible. Moreover, dentists and other medical professionals are held to a higher standard when it comes to abiding by controlled substance laws and regulations. In addition to paying civil penalties for violations of the Controlled Substances Act, the dentist in the above-referenced article was stipped of his DEA registration by the Minnesota Board of Dentistry last summer. The best decision you can make to protect your practice from potential liabilities is to consult an attorney who provides legal services to dental professionals.