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ADA president shares the story of dentistry, policy on opioids

Pain consortium includes NIDCR director on agency’s actions

June 03, 2019

By Jennifer Garvin

Jeffrey M. Cole
Policy talk: ADA President Jeffrey M. Cole talks about the ADA’s opioid policy during the 2019 NIH Pain Consortium.
Bethesda, Md. — Standing in a room full of national health care leaders and researchers in pain management and substance use disorders, ADA President Jeffrey M. Cole told a story.

He told the story of an Association driven to do its part to alleviate the nation’s opioids crisis.

He talked of ADA members personally being affected by substance use disorders either from their own addictions or someone in their family.

He showed how all of it — the tragedies, the 24-hour news cycle, the desire for dentists to help — led the Association to groundbreaking territory in 2018, when the ADA became one of the first health care professional associations to create policy mandating continuing education and initial prescribing limits for opioids.

“Seeing what was happening within our dental family— and caring about what was happening all over the country— our volunteer leaders asked the ADA Board to take more aggressive action to guide the Association’s work on the opioid crisis,” Dr. Cole said.

Dr. Cole was speaking as part of the 2019 NIH Pain Consortium, held May 30-31 at NIH.

The ADA’s 2018 opioids policy caught the attention of the National Institutes of Health, which invited the Association to take part in the event. Each year, the pain consortium gathers researchers to enhance pain research and promote collaboration among the NIH branches for programs and activities addressing pain.

“We knew we had to take action,” Dr. Cole continued. “But developing new policy quickly would not be easy.”

Dr. Cole shared a behind-the-scenes look at how new policy gains life at the ADA. The normal course of action, he said, would have been for the ADA Board to discuss topics for consideration before sending them to the ADA House of Delegates to approve when it convened in October 2018.

“But in this case, it was February 2018 and as a result, the Board considered an interim opioid policy,” Dr. Cole said. “There were risks if the Board did not get it right. If the policy was not ratified by the House or if it was amended, the ADA ran the risk of losing its credibility with legislators and policymakers as well as its own members. Despite these risks, the ADA Board had the courage in an emergency meeting to adopt the aggressive opioid policy as interim policy.”

In the year prior and up to the ADA Board adopting the interim policy, stories were coming to light about dentists and dental students struggling with substance use disorders and wellness in their own families.

There was Dr. Omar Abubaker, an oral surgeon and educator in Virginia, whose son Adam died from a mixture of heroin and benzodiazepines at 21.

And Ohio’s Dr. Sharon Parsons who lost her own son to a heroin overdose following an addiction battle ignited by an opioids prescription for an injury.

And Jiwon Lee, a former American Student Dental Association president and Columbia University dental student, who took her own life after struggling with depression.

Dr. Cole shared these stories. He also went back to a dentist he knew who had survived something similar and turned helping others overcome addiction into his personal crusade: Dr. Brett Kessler.

“As a resident he was struggling with a substance use disorder and he eventually called the ADA for help,” Dr. Cole said. “The ADA had resources that steered him into his lifetime journey of recovery. Brett became an advocate. He speaks regularly to dental groups and the ADA well-being conference on recovery and sobriety.  But he often lamented that it was difficult to bring the discussion substance use disorders above the line. He felt the discussion never got the attention it deserved. He struggled getting his messages to the larger audiences.”

That changed, Dr. Cole said, when Dr. Kessler met Austin Eubanks, a survivor of the Columbine High School shootings in Colorado, who became addicted to opioids after recovering from his injuries. Mr. Eubanks was the keynote speaker at the ASDA National Leaders Conference in October 2017 that Dr. Cole attended along with 800 dental students.

“That is when I first met Austin and he had a profound effect on me,” Dr. Cole said. “I knew then I needed to get his message out to the leaders of our profession.”

Dr. Cole credited Mr. Eubanks, who shared his story of survival and addiction with an audience at the 2018 ADA Presidents-elect Conference in Chicago.

“There was no discussion or dissension at that meeting about our interim policy. Only a standing ovation for Austin,” Dr. Cole recalled. The opioid policy later passed the ADA House of Delegates on the consent calendar, without discussion.

“It was empathy on the most human level, a personal connection to the pain caused by substance use disorders, which allowed our profession to support bold action and help victims of this horrible crisis,” Dr. Cole said. “We owe it to our colleagues, like Dr. Brett Kessler, whose path to recovery started with a phone call to the ADA. We owe it to every patient who sits in our chair. We owe it to the families and colleagues who suffer, and to all those who have died from a drug overdose.”

Dr. Martha Somerman and Jeffrey M. Cole
Collaboration: Dr. Martha Somerman, director, NIDCR, and ADA President Jeffrey M. Cole share a moment during the NIH Pain Consortium.
If this were a movie, Dr. Cole’s speech would have concluded here. He needed to tell the audience what came next and why all health care stakeholders need to continue exploring every avenue to ending pain and addiction.

“Two weeks ago, I was sitting in a dental meeting in Juneau, Alaska, when I received a text from Dr. Kessler,” said Dr. Cole. “He told me Austin Eubanks was found dead that morning. He was 37.”

In statements to the press, Mr. Eubanks’ family has said, “he lost the battle with the very disease he fought so hard to help others face.”
 
“I started my remarks by saying that the ADA is a community, a circle of strength of love and support. I guess that is why Austin connected so well with our dental community. Brett reminded me that our obligation now as leaders was to move Austin’s message forward. I hope I was able to do that today,” Dr. Cole concluded.

Said Dr. Kessler, “Substance use disorder is a chronic, relapsing and sometimes fatal disease.  Sometimes, even with the best treatment, it still takes a life. Our policy allows us to be a vital part in preventing this from ever happening, while using best practices for pain management for our patients.”

Prior to Dr. Cole’s remarks, Dr. Martha Somerman, director, National Institute of Dental and Craniofacial Research, introduced the ADA’s 155th president by thanking the Association’s work on opioids.

“In the past, a dentist wrote an opioids prescription and it was probably too much,” Dr. Somerman said. “[Dentists] were previously listed as the third most frequent prescriber of opioids. This has gone down because the American Dental Association’s leadership stepped up and the dentists responded and opioid behaviors and patterns have changed.

“In fact, one of the areas NIDCR is investing in is not implementation but de-implementation. We’re funding a study on how to de-implement [providers] who are used to writing prescriptions and want to get their patients out of pain but when is it appropriate and when it is not. The dentists are ahead of the curve relative to the physicians in terms of responding to the opioid crisis and we need to better think strategies on what are the appropriate medications for different types of pain,” she said.

Dr. Somerman also mentioned the upcoming U.S. Surgeon General’s 2020 Report on Oral Health, which will contain a chapter devoted to pain management and orofacial pain.

In 2018, Dr. Somerman, along with Nora Volkow, M.D., director, National Institute on Drug Abuse, penned a commentary for The Journal of the American Dental Association on the role of dentists in the opioid crisis that included relevant NIH-funded research and ways to amplify dissemination of that research to clinicians and educators.

“Thank you, Dr. Somerman and NIDCR and Dr. Volkow for being champions of dentistry and for pain management,” Dr. Cole said.

This was the 14th NIH Pain Consortium. NIH established the annual event to enhance pain research and promote collaboration among researchers across the many NIH Institutes and centers that have programs and activities addressing pain. For more information, visit painconsortium.nih.gov/index.html.