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CDC Report: Drug Overdose Fatalities Reach Record Highs in 2014

December 21, 2015 A report1 in an early release issue of the Centers for Disease and Prevention (CDC) Morbidity and Mortality Weekly Report (MMWR) describes an increase in drug overdose death rate of 137% since the year 2000, including a 200% increase in overdose deaths involving opioids (i.e., opioid pain relievers and heroin). In 2014, there were 47,055 drug overdose deaths in the U.S., representing a 1-year increase of 6.5% compared with 2013; the 2014 drug overdose fatality rate exceeds the death rate from motor vehicle accidents by 1.5 times. Since 2000, the age-adjusted drug overdose death rate has more than doubled, from 6.2 per 100,000 persons in 2000 to 14.7 per 100,000 in 2014, while the rate of opioid overdose deaths has tripled since 2000. The authors called for strengthening of efforts to encourage safer prescribing of opioid pain relievers. Other key prevention strategies identified includes expanding availability and access to the opioid reversal agent naloxone, increasing access to medication-assisted treatment in combination with behavioral therapies, and increasing access to syringe service programs to prevent the spread of hepatitis C virus infection and HIV infections.

It has been estimated that dentists write approximately 10% of all prescriptions for immediate-release opioids in the U.S.2, 3 A 2014 registry study4 from the Utah Controlled Substance Database estimated that dentists were responsible for writing 8.7% of opioid prescriptions in Utah from 2002 through 2010 and that 4.9% of all opioid fatalities (comprising 0.64% of opioid prescriptions) during that same time frame could be linked back to a dental prescription.  In 2011, a paper in JADA by Denisco et al.5 reported findings from a March 2010 meeting regarding the role of dentists in preventing opioid abuse held in Boston and co-hosted by the Tufts Health Care Institute Program on Opioid Risk Management and the Tufts University School of Dental Medicine. The authors suggested that dentists, along with other prescribers, “take steps to identify problems and minimize prescription opioid abuse through greater prescriber and patient education; use of peer-reviewed recommendations for analgesia; and, when indicated, the tailoring of the appropriate and legitimate prescribing of opioids to adequately treat pain.” In terms of implications for practice, the authors encouraged dentists “to incorporate practical safeguards when prescribing opioids, consistently educate patients about how to secure unused opioids properly, screen patients for substance use disorders and develop a referral network for the treatment of substance use disorders.”

Factors associated with decreases in dental opioid prescribing include use of mandatory prescription drug monitoring plans (PMDPs)6 and adoption of evidence-based prescription practices for acute postoperative dental pain (i.e., combination ibuprofen/acetaminophen for acute postoperative dental pain management).7

References
1.    Rudd RA, Aleshire N, Zibbell JE, Gladden RM. Increases in Drug and Opioid Overdose Deaths — United States, 2000–2014. MMWR Morb Mortal Wkly Rep 2015;64(Early Release):1-5.
2.    Volkow ND, McLellan TA, Cotto JH, Karithanom M, Weiss SR. Characteristics of opioid prescriptions in 2009. JAMA 2011;305(13):1299-301.
3.    Rigoni GC. Drug utilization for immediate- and modified release opioids in the U.S. Silver Spring, MD: Division of Surveillance, Research & Communication Support, Office of Drug Safety, U.S. Food and Drug Administration 2003. Accessed December 21, 2015.
4.    Porucznik CA, Johnson EM, Rolfs RT, Sauer BC. Specialty of prescribers associated with prescription opioid fatalities in Utah, 2002-2010. Pain Med 2014;15(1):73-8.
5.    Denisco RC, Kenna GA, O'Neil MG, et al. Prevention of prescription opioid abuse: the role of the dentist. J Am Dent Assoc 2011;142(7):800-10.
6.    Rasubala L, Pernapati L, Velasquez X, Burk J, Ren Y-F. Impact of a mandatory prescription drug monitoring program on prescription of opioid analgesics by dentists. PLoS ONE 2015;10(8):e0135957.
7.    Moore PA, Hersh EV. Combining ibuprofen and acetaminophen for acute pain management after third-molar extractions: translating clinical research to dental practice. J Am Dent Assoc 2013;144(8):898-908.

About Science in the News

Science in the News is a service by the American Dental Association (ADA) to its members to present current information about science topics in the news. The ADA is a professional association of dentists committed to the public's oral health, ethics, science and professional advancement; leading a unified profession through initiatives in advocacy, education, research and the development of standards. As a science-based organization, the ADA's evaluation of the scientific evidence may change as more information becomes available. Your thoughts would be greatly appreciated.