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ADA asks Congress to include one-time surgical procedures in response to opioid crisis

October 09, 2017

By Jennifer Garvin

Washington — The ADA on Oct. 5 submitted a statement to the Senate Committee on Health, Education, Labor and Pensions recommending that the federal response to the opioid crisis “begin to address the nuances of managing acute pain following one-time surgical procedures, such as a wisdom tooth extraction.”

The Association also recommended that prescriber education opportunities be coordinated with professional societies, administered by accredited continuing education providers and recognized for state licensure purposes.

In the statement, the ADA said that the federal government has invested “considerable time and resources to raise professional awareness about the opioid epidemic and encourage more judicious prescribing of opioid pain medications” but noted that it has “not sufficiently distinguished pain management in dentistry from pain management in medicine, specifically when it comes to managing acute pain versus chronic pain.”

For examples of this, the Association cited the Centers for Disease Control and Prevention Guideline for Prescribing Opioids for Chronic Pain and Food and Drug Administration’s Risk Evaluation and Mitigation Strategy for Extended Release and Long Acting Opioid Analgesics.

“While long acting opioids can be useful in managing chronic pain, there is rarely, if ever, a need to manage chronic pain following a one-time dental surgery (e.g., wisdom tooth extraction, etc.), much less to prescribe a long acting opioid,” the ADA wrote.

The ADA noted that some federal activities have been more beneficial than others, particularly the Substance Abuse and Mental Health Services Administration’s Providers’ Clinical Support System for Opioid Therapies.

Since 2012 the Substance Abuse and Mental Health Services Administration and the American Academy of Addiction Psychiatry have provided a grant enabling the ADA to offer free online continuing education webinars covering the latest pain management techniques in dentistry with an emphasis on judicious prescribing of short acting opioids. The ADA also singled out the National Institute of Dental and Craniofacial Research for its current research on the biological triggers of dental pain and novel ways to alleviate it using non-narcotic therapies.

“We were pleased by a recent statement from FDA Commissioner Scott Gottlieb, M.D., suggesting that the agency will be revisiting its risk management program to ensure opioid prescribing is better tailored to the medical indication,” the ADA wrote. “We hope this is an indication that federal agencies are beginning to appreciate that acute pain is managed differently from chronic pain.”

For several years, the ADA has sought to raise professional awareness of opioids abuse and mobilize dentists to take action. In July 2016, then ADA president Dr. Carol Gomez Summerhays issued a Dear Colleagues message urging dentists to take several specific steps to help prevent opioid abuse, misuse, and diversion.

The ADA has also worked with federal agencies and private groups to raise professional and consumer awareness. In August 2016, the ADA joined the Surgeon General’s Turn the Tide campaign to mobilize health care professionals to improve their prescribing practices. The ADA has supported the Drug Enforcement Administration’s National Prescription Drug Take Back Initiative, and the Partnership for Drug-Free Kids’ Medicine Abuse Project.

Additionally, the Association has collaborated with members of Congress to pursue common sense solutions to help end opioid abuse. In September, the Association worked with Sen. Elizabeth Warren, D-Mass., and Sen. Shelley Moore Capito, R-W.Va., to explore ways to promote new partial fill authority granted to prescribers following passage of the Comprehensive Addiction and Recovery Act of 2016. The partial fill provision, which the ADA supported, authorizes pharmacies to partially fill prescriptions for Schedule II controlled substances when requested by the patient or prescriber, and to fill the remaining portions after a specified date without further authorization from the prescriber, subject to state law.

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