Policy supports mandates on opioid prescribing and continuing education

CHICAGO, March 26, 2018 — The American Dental Association (ADA) announced a new policy on opioids supporting mandates on prescription limits and continuing education in what could be the first of its kind among major health care professional organizations.

The policy states:

• The ADA supports mandatory continuing education in prescribing opioids and other controlled substances.
• The ADA supports statutory 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 evidence-based guidelines.
• The ADA supports dentists registering with and utilizing Prescription Drug Monitoring Programs (PDMPs) to promote the appropriate use of opioids and deter misuse and abuse.

“As president of the ADA, 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, D.D.S. “This new policy demonstrates ADA’s firm commitment to help fight the country’s opioid epidemic while continuing to help patients manage dental pain.”

Most opioids prescribed to patients in the U.S. are written by physicians and other medical professionals for management of chronic (long-term) pain. Dentists with an appropriate license may also prescribe opioids, and do so most often for management of acute (short-term) pain such as severe tooth decay, extraction of teeth and root canals. 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. By 2012, this number had fallen to 6.4 percent.

New data published in the April issue of The Journal of the American Dental Association (JADA) continue to shed light on opioid prescriptions from a dental perspective. The data indicate:

• Benefits and Harms Associated with Analgesic Medications Used in the Management of Acute Dental Pain: Authors examined five systematic reviews and concluded non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and acetaminophen are equal or superior to using opioids for dental pain. The findings support the ADA’s 2016 policy statement that dentists “consider [NSAIDs] as the first-line therapy for acute pain management.”
  • Opioid Prescribing Practices from 2010 through 2015 Among Dentists in the United States: Authors from the ADA Health Policy Institute used data in several existing databases to review opioid prescription claims from 2010 to 2015 for about 1.1 million privately insured dental patients. Findings indicate that patients who received an opioid prescription from a dentist were given a median supply to last three days. Across all age groups over a six-year period, opioid prescriptions increased by 17 per 1,000 dental patients. The largest increase in opioid prescriptions was among patients aged 11 to 18; and 11-18 and 19-25 age groups received a higher median dose than all other age groups.
  • Gender and Race/Ethnic Disparities in Opioid Prescriptions for Dental Diagnoses among Patients with Medicaid: Authors reviewed claims of more than 890,000 Medicaid patients from 13 states between 2013 and 2015. Findings indicate emergency departments prescribed opioid medications almost five times more often than dentists and nurse practitioners prescribed opioids nearly three times as often compared to dentists. Women were 50 percent more likely than men to receive an opioid prescription for pain management of a dental condition. Both Whites (non-Hispanic) and African-Americans were around twice as likely to receive an opioid prescription as Hispanics.
• Prescription Monitoring Program (PMP) Data: Authors from Harvard School of Dental Medicine, Tufts University School of Dental Medicine and a retired Massachusetts State Police Detective Lieutenant provided 10 clinical scenarios dental prescribers might encounter and how to assess the PMP data from a clinical, risk assessment and law enforcement 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 health care 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 www.ADA.org/opioids.

Wednesday, March 14, was the final day of the 2018 legislative session. With a grinding day that saw 57 conference committee reports hitting legislators’ desks, all knew it would be a long day, but no one anticipated an ending that Speaker Bosma would describe as “chaotic.” Despite an unprecedented “extension” past the midnight deadline, legislators still left issues surrounding school safety and gun regulation unfinished. Still, the IDA was able to marshal legislation through the process that produced a measure to increase access to dental care for Hoosiers.

HEA 1116, included in IDA’s legislative package and authored by Reps. David Frizzell, Dr. Denny Zent and Robin Shakleford, unanimously passed the Indiana General Assembly and is headed to Governor Holcomb. The bill, supported by both the IDA and the Indiana Dental Hygienists Association (IDHA), will allow dental hygienists to provide preventive hygiene services without the direct supervision of a dentist in non-private practice settings. The intent is to allow hygienists more flexibility in providing preventive services in public health settings. The measure has been praised by Indiana legislators as a positive step toward enhancing access to oral health preventive services.

Opioid Measures Head to the Governor’s Office

SEA 221 will phase in INSPECT participation requirements between July 1, 2018, and July 1, 2021. By 2021, all practitioners would be required to consult INSPECT prior to prescribing an opioid.

SB 225 will require all health care prescribers of narcotics to receive two hours of CE in opioid prescribing and opioid abuse. Dentists who maintain a controlled substance registration and DEA permit would need to complete this CE by the end of the 2020 licensure cycle. The Indiana State Board of Dentistry has the charge of approving which CE programs will fulfill the legislations requirement. The IDA is already in communication with the ISBD with suggestions for CE programs.

Healthcare Workforce Surveys

SEA 221 requires healthcare providers, including dentists, to provide information related to the their practice, including information regarding their Medicaid practice, when renewing a professional license online. The measure also requires the Indiana Professional Licensing Agency to compile the information collected into an annual report; post a copy of the report on the agency’s Internet web site; and submit the report to the office of Medicaid Policy and Planning, the Department of Workforce Development, the Commission on Improving the Status of Children, the Legislative Council, and the Office of the Attorney General.

Two pieces of the IDA legislative package did not survive the 2018 session.

HB 1049, authored by Rep. Denny Zent, would have required dental insurance companies to annually report their claims loss ratios to the Indiana State Department of Insurance, and for the Department of Insurance to make the information available to the public. IDA testified that the requirement could be a helpful tool to employers, allowing them to assess if insurance companies were making efficient use of the employer’s premium dollars. The House Insurance Committee listened to testimony; unfortunately the bill was not called for a vote.

SB 183, authored by Sen. Jim Merritt, would have amended Indiana’s current definition of the practice of dentistry to reflect broader model language recommended by the ADA. The bill did not get a hearing, but Senator Merritt has committed to reintroduce a standard definition bill during the 2019 Legislature.

Elections are just around the corner and there is an historic number of legislative retirements this year. Please get to know your candidates and contact Ed Popcheff, Director of Governmental Affairs, at ed@indental.org to become a contact dentist.

The Indiana Dental Association Foundation for Dental Health, in conjunction with the IndianaMOM Partner Grant Program, has recently awarded a grant to the Indiana University Student Outreach Clinic (SOC) The funds will be used to benefit patients in near Eastside Indianapolis through the free dental clinic while providing a unique educational experience for IUSD student and faculty volunteers.

The SOC is a student-run free clinic with an executive board of 18 dental students who run clinic session as well as behind-the-scenes operations. The clinic operates two or three Saturdays each month through People’s Health and Dental Center at 2340 East 10^th Street in Indianapolis.

During the 2015-16 academic year, the clinic treated 121 patients during 261 patient visits. During that time, the student volunteers provided $36,189 in dental care according to Medicaid values. In private practice settings, this would equate to over $72,000 of dental care.

SOC board members are proud that the clinic is beginning to serve as a dental home for patients to receive routine dental care rather than emergency-only care while also serving as a one-of-a-kind, hands-on and interdisciplinary experience for student volunteers. During the same academic year, over 184 individual volunteers served over 1,940 hours, overseen by 13 active IUSD faculty members. The clinic provides the only opportunity for dental students to work with and learn from their future dental hygiene colleagues.

The SOC board would like to extend an invitation to all IDA members to visit the Student Outreach Clinic and have any questions answered. To arrange a tour, contact SOC Chair Andrew Bartels at arbartel@iu.ed.

Indiana University President Michael A. McRobbie presided over today’s dedication of the James J. Fritts, DDS Clinical Care Center, a new state-of-the-art oral health care clinic at the Indiana University School of Dentistry at IUPUI. The 45,000-square-foot facility is part of a plan to ensure Indiana’s only dental school is among the best in the world. The building bears the name of Dr. James. J. Fritts, a 1965 dental school graduate.

“This splendid new clinical care center will make the IU School of Dentistry one of the most technologically advanced dental schools in the United States,” McRobbie said. “It is a facility of the highest quality that will help the school recruit and retain outstanding faculty and students. It will also allow our students to train in a state-of-the-art technological environment, and it will serve countless patients by promoting optimal oral health.

“I want to express our most grateful thanks to Dr. James Fritts, whose generosity will touch the lives of countless students, faculty, staff and patients and help the IU School of Dentistry continue to thrive for generations to come.”

Other speakers at the dedication were IUPUI Chancellor Nasser H. Paydar; IU School of Dentistry Dean Dr. John N. Williams; Fritts; Dr. Timothy Carlson, professor and clinical director; and Leah Stetzel, president of the dental student class of 2020.

“The Fritts Clinical Care Center is emblematic of the exceptional health sciences research and translational practice taking place at IUPUI,” Paydar said. “As IU prepares to celebrate its bicentennial, and IUPUI commemorates 50 years as a campus, the Fritts Clinical Care Center embodies the university’s mission by providing exceptional teaching, research and community oral health care,” Paydar said. “It is a shining example of philanthropy used to improve the well-being of humanity.”

The Fritts Clinical Care Center includes 125 new patient treatment chairs, which have been designed to maximize ergonomics for dental students and supervising faculty. The building design blends the contemporary building with the historic limestone façade of the original structure. The eastern exposure bathes the clinic floors in natural light. A covered drop-off and spacious lobby and waiting areas welcome patients. Artwork donated by Dr. R. Stephen Lehman, an alumnus of the dentistry and prosthodontics programs, decorates the walls and alcoves.

This is the first addition to the dental school in 40 years. A courtyard and a suspended walkway connect the Fritts Clinical Care Center with the dental school’s three other buildings. The new clinical building is LEED Silver certified.

“Today, we celebrate the completion of a 21st-century clinic for a 21st-century dental school,” Williams said. “We are immensely grateful to the supporters who enabled us to match a world-class facility with world-class dental education, research and clinical care.”

The IU School of Dentistry raised more than $8.7 million of the approximately $21.6 million needed for the Fritts Clinical Care Center through For All: The Indiana University Bicentennial Campaign.

In 2017, students supervised by licensed faculty provided oral health care to more than 19,000 people during approximately 86,000 appointments. The Fritts Clinical Care Center also has capacity for extended hours of care.

 

About the Indiana University School of Dentistry

The only dental school in the Hoosier state, the IU School of Dentistry offers an extraordinary learning environment in which teaching, research and community service come together in the best way possible for the preparation of tomorrow’s dental professionals. Founded in 1879 as the Indiana Dental College, the school is in the heart of the state capital of Indianapolis on the IUPUI campus. IUSD shares its location with the world-renowned IU School of Medicine and its partner, the IU Health academic health center, and services more than 19,000 clinical patients per year. More than 80 percent of the dentists in Indiana are alumni of the IU School of Dentistry.