ADA Adopts Interim Opioids Policy

The new policy, officially titled Interim Board Policy on Opioid Prescribing, is believed to be one of the first of its kind from a major health professional organization. 

"I call upon dentists everywhere to double down on their efforts to prevent opioids from harming our patients and their families," said ADA President Joseph P. Crowley. "This new policy demonstrates the ADA's firm commitment to help fight the country's opioid epidemic while continuing to help patients manage dental pain."

In the interim policy, the Association says it supports the following:

• Mandatory continuing education on prescribing opioids and other controlled substances.
• Prescribing limits on opioid dosage and duration of no more than seven days for the treatment of acute pain, consistent with the Centers for Disease Control and Prevention's evidence-based guidelines.
• Dentists registering with and utilizing prescription drug monitoring programs to promote the appropriate use of opioids and deter misuse and abuse.
  In 2016, opioids (including prescription opioids, heroin and fentanyl) killed more than 42,000 people — more than any year on record — and 40 percent of those deaths involved a prescription pain reliever, according to the Centers for Disease Control and Prevention. 

The White House has made reducing the number of U.S. deaths attributed to opioids a key priority of the Trump Administration and Congress has followed suit. To date, more than 130 opioids bills have been introduced in Congress since the 115th Congress began in Jan. 2017. 

At the national level, the ADA has been pursuing common sense policies to keep opioid pain relievers from harming dental patients and their families. This includes in 2016 successfully lobbying the Comprehensive Addiction and Recovery Act that supports a number of activities to help prevent opioid misuse and abuse. In March, Dr. Crowley was part of a select group of health care organization representatives invited to participate in national opioids summit on the topic.

At the upcoming ADA and American Student Dental Association Lobby Day, April 8-10 in Washington, D.C., dentists and students will advocate together on dentistry's role in preventing opioid abuse.

The ADA Board of Trustees adopted the interim policy after it was drafted and submitted by the ADA Council on Government Affairs during its March meeting. The council also received guidance on crafting the interim policy from the ADA councils on Scientific Affairs, Dental Education and Licensure and Dental Practice. 

"Legislators on both sides of the aisle routinely tell us that the health professions have not done enough to curb over prescribing," said Dr. Frank Graham, CGA chair. "We are constantly asked about mandatory continuing education and prescribing limits. The intensity of this is unlike anything we've ever seen. It comes up at every meeting we have — with Republicans and Democrats alike."

"This is a serious public health issue," Dr. Graham added. "It's pressing enough that we asked the Board for a clear and meaningful interim policy to guide our advocacy efforts."

The ADA first adopted policy on opioids and treating dental pain in 2005. That policy was updated in 2016 and includes recommendations for dentists to consider nonsteroidal anti-inflammatory analgesics as the first-line therapy for acute pain management. 

That ADA policy is supported in the April Journal of the American Dental Association article, "Benefits and Harms Associated with Analgesic Medications Used in the Management of Acute Dental Pain." In that article authors from the University of Pittsburgh School of Dental Medicine, the American Dental Association, Case School of Dental Medicine and The Ohio State University examined five systematic reviews that explored the effectiveness and/or adverse events associated with the use of oral medications for acute pain relief. They found, that for adults, a combination of 400 mg of ibuprofen plus 1000 mg of acetaminophen was found to be superior to any opioid-containing medications studied.

The ADA continues to raise professional awareness about prescription opioid abuse, encouraging dentists to complete Continuing Education Provider Recognition training in model opioid prescribing and urging them to register with their state prescription drug monitoring programs.

Most opioid prescriptions for patients in the U.S. are written by physicians and other medical professionals for management of chronic pain, according to annual research compiled by the IMS Health National Prescription Audit. 

In a 2012 article in the Journal of Preventive Medicine, researchers noted that in 1998 dentists were the top specialty prescribers of opioid pain relievers, accounting for 15.5 percent of all opioid prescriptions in the U.S. However, by 2012 this number had fallen to 6.4 percent.

For six years, the ADA has offered free online continuing education courses on safe and effective opioid prescribing for dental pain. The next webinar, scheduled for April 25, explores how dentists can use their Drug Enforcement Administration prescribing authorities to reduce prescriptions for dental pain.

Also on March 26, the ADA published the April JADA, which features four cover articles on opioid prescriptions from the dental perspective. 

"The JADA articles shine an important light on a public health epidemic from the dental perspective, and signal that while the percentage of opioids prescribed by dentists has decreased since 1998, we can continue to do even more to help keep opioids from being a source of harm," said Dr. Crowley. "Working together with physicians, pharmacies, other healthcare professionals, policymakers and the public, we believe it is possible to end this tragic and preventable public health crisis that has been devastating our families and communities."

For more information on how the ADA is working to combat opioid abuse, visit ADA.org/opioids.