Educate Patients about Addictive Qualities of Painkillers

Click here to view the ADA's official policies, positions, and statements on alcoholism, drug addiction, and other substance use disorders, as adopted by the House of Delegates. A few of these policies are summarized below.

Among other things, the ADA encourages dentists to:

• Follow and continually review Centers for Disease Control and Prevention and state licensing board recommendations for safe opioid prescribing.
• Be aware of each patient's substance use history and to take this into consideration when planning treatment and prescribing medication.
• Consider nonsteroidal anti-inflammatory analgesics as the first-line therapy for acute pain management.
• Counsel patients about the benefits and drawbacks of using opioid analgesics, including their inherent abuse potential, and provide instruction on how to safely secure, monitor, and dispose of their unused medication at home.
• Screen patients for risky substance use behaviors and, when indicated, be able to refer them for appropriate treatment (e.g., support line, addiction counselor, treatment facility, etc.).
• Register with and use the state prescription drug monitoring program to promote the appropriate use of controlled substances for legitimate medical purposes, while deterring the misuse, abuse and diversion of these substances.
• Seek continuing education in addictive disease and pain management as related to opioid prescribing.

Click here for additional recommendations from the ADA. 

These statements should not be construed as clinical guidelines or a standard of care, and are not intended to replace the independent judgment of the dental practitioner. The field of pain management is ever evolving and dentists are encouraged to stay abreast of the latest developments in the field.

These and other topics are explored in depth in the ADA Practical Guide to Substance Use Disorders and Safe Prescribing.

Until the CDC publishes a guideline for prescribing opioids for acute pain, the ADA recommends that dentists review and follow the relevant portions of the CDC Guideline for Prescribing Opioids for Chronic Pain (2016), subject to state law.

The CDC recommendations should not be construed as clinical guidelines or a standard of care, and are not intended to replace the independent judgment of the dental practitioner. The field of pain management is ever evolving and dentists are encouraged to stay abreast of the latest developments in the field.

Additional information is available at CDC.gov.

Check with your state controlled substance authority to determine whether your state allows electronic prescribing of Schedule II controlled substances.

In 2010, the Drug Enforcement Administration amended its regulations to provide practitioners with the option of issuing electronic prescriptions for controlled substances in lieu of paper prescriptions (see 75 FR 16235, March 31, 2010), subject to state law. 

Again, check with your state controlled substance authority to determine whether your state allows electronic prescribing of Schedule II controlled substances.

Information is also available at DEA.gov.

Check with your state controlled substance authority to determine whether your state allows partial filling of Schedule II controlled substances. Sec. 702 of the Comprehensive Addiction and Recovery Act of 2016 (21 U.S.C. 829(f)) permits dentists to request that their prescriptions for Schedule II controlled substances be only partially filled, subject to state law. It also allows pharmacies dispense the remaining portions in increments without further authorization from the prescriber.

This partial fill authority only applies where it is not otherwise prohibited by state law.

Again, check with your state controlled substance authority to determine whether your state allows partial filling of Schedule II controlled substances.

Information is also available at DEA.gov.

The Drug Enforcement Administration does not currently require advanced training in pain management, prescribing controlled substances, and/or chemical dependency as a condition of obtaining or renewing a DEA registration to prescribe controlled substances. However, many states require dentists to complete such training as a condition of licensure renewal.

Check with your state dental board or controlled substance authority to determine whether your state requires such training and, if so, what the requirements are.

The ADA encourages dentists to seek continuing education in Screening, Brief Intervention, and Referral to Treatment (SBIRT) for patients who may be at risk for substance abuse and/or or be prone to addiction.

SBIRT is an evidence-based practice used to identify, reduce, and prevent problematic use, abuse, and dependence on alcohol and illicit drugs. It is comprised of three basic components.

• Screening — Specialized techniques for identifying risky substance use behaviors.
• Brief Intervention — Specialized techniques for motivating at-risk individuals to change their behavior.
• Referral to Treatment — Specialized techniques for referring these patients for appropriate diagnosis and treatment (e.g., support line, addiction counselor, treatment facility, etc.).

SBIRT is based on an Institute of Medicine recommendation* that called for community-based screening for health risk behaviors.

These and other topics are explored in depth in the ADA Practical Guide to Substance Use Disorders and Safe Prescribing.

Information is also available at SAMHSA.gov/sbirt.

______________________
* Institute of Medicine, Committee on Quality of Health Care in America (IOM). Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC, 2001.

If you or someone you love is struggling with addiction, call the Substance Abuse and Mental Health Services Administration hotline at 1-800-662-HELP (4357). It's confidential, free, and available 24 hours a day, 365 days a year.

You can also find a treatment center near you.