Opioid prescribing and misuse among dental patients in the US: a literature-based review
Conclusions: There is moderate recognition of the contribution of dental prescriptions to the opioid epidemic. Several tools are available to increase patient education and practitioner knowledge about the safe use of opioids with a focus on patients at greatest risk.
If we can say anything for certain about caring for persons in pain over the past decade is that it has prompted concern and confusion on how to provide the best care. Consider the following: Do we have an opioid epidemic or an opioid crisis in the United States? Does the difference in these words matter? What about the “other” less publicized public health crisis; chronic pain; where did that conversation go? Are opioid analgesics good or bad to treat people in pain? Should nurses be prepared in pain care, addiction care or both? What are the differences in state policies that govern and guide nursing practice...
Opioid addiction has reached epidemic proportions in the United States and it is thought that the problem started with the prescription for legal pain medications by health care professionals, particularly for treating patients who had undergone surgery. To reduce the reliance on opioids in dental pain management, increase use of nonsteroidal anti-inflammatory drugs (NSAIDs) and other adjunctive techniques have emerged. The use of NSAIDs, transdermal and transmucosal patches are presented. Understanding the rational for these different approaches requires a basic knowledge of the molecular biology of dental pain.
A new consensus report from the National Academies of Sciences, Engineering, and Medicine aims to address the US epidemic of opioid misuse and overdose while ensuring effective pain management.Medscape Medical News
This article summarizes the evolution of an opioid management toolkit using a quality improvement (QI) approach to improve prescribing. Methods: The authors developed a list of opioid-prescribing best practices and offered in-office, team-based QI projects to ambulatory clinics, updated and tested over 3 trials in the form of a toolkit. Outcome measures included pre- and postproject surveys on provider and staff satisfaction, toolkit completion, and process measures. The toolkit supports workflow planning, redesign, and implementation. Results: Ten clinics participated in trial 1, completing the QI project on average in ...
Conclusion: The Lewin and 7S models of change can be helpful guides to creating and maintaining a foundation of office-wide culture and structural support to meet the twin goals of safe opioid prescribing and treating patients with OUD.
This study aimed to explore the effect of Transcutaneous Electrical Nerve Stimulation (TENS) therapy in the pain management of women after CD.
Conclusion: A pathway for creating evidence-based opioid-prescribing recommendations can be utilized in diverse practice environments and can lead to significantly decreased opioid prescribing without adversely affecting patient outcomes.
DISCUSSION: These qualitative data document practical issues that should be considered in the development of implementation plans for safer opioid prescribing practices. Specifically, healthcare systems may need to provide opioid-relevant communication strategies and training, education on key topics such as naloxone prescribing, resources for referrals to appropriate nonpharmacologic treatments, and innovative IT solutions. Future research is needed to establish that such measures will be effective in producing better outcomes for patients on opioids for chronic pain. PMID: 31850509 [PubMed - in process]
ConclusionsDental-related pain is often managed by nondental health care professionals in an ED or urgent care setting. An EHR alert may help quickly identify high-risk patients; however, the impact of alerts on prescribing patterns needs further evaluation. The decision regarding the type and quantity of medication to prescribe is complicated by lack of patient access to definitive dental treatment and lack of dental-specific training of prescribers. The limitations of this study include selective inclusion of encounters with specific ICD-9/ICD-10 codes, data limited to objectively searchable criteria, data collection for...
The National Institutes of Health (NIH) estimates that in 2018, over 10 million teens and adults misused opioids. The prescription of opioids to treat patient pain is one of many factors contributing to this epidemic; to solve it, a multipronged approach is needed. Two new Mayo Clinic studies -- one in clinical practice and one in the laboratory -- could [...]