The State of Dental Prescriptions

Opioids are daily news nationwide and in the state. Indiana news outlets have labeled the level of opioid and heroin addiction in Indiana as a “plague, crisis, and epidemic.” These melodramatic terms are not exaggerating in light of the statistics.

Statistics

According to the National Center for Health Statistics, estimates for drug related overdose deaths for the first nine months of 2016 were higher than the previous years and reached and all-time high of 52,404. Of those, more than 33,000 were attributed to opioid drugs including legal prescription painkillers as well as illicit drugs like heroin and street fentanyl. A White House panel commissioned to examine the nation’s opioid epidemic reported:

“Our citizens are dying…Declare a national emergency… 142 Americans die from drug overdose every day… Since 1999, the number of American overdose deaths involving opioids quadrupled. From 2000 to 2015, more than 500,000 people died of drug overdoses, and opioids account for the majority of those. The average American would likely be shocked to know that drug overdoses now kill more people than gun homicides and car crashes combined.”

[su_pullquote align=”right”]Dentists prescribe 12 percent of IR opioids in the United States, second only to family physicians, who prescribe 15 percent of IR opioids.[/su_pullquote]In Indiana, 809 people died of drug overdose in 2009. Last year, Indiana deaths from drug overdose totaled 1,357, a 67% increase from 2009. Northern Indiana’s St. Joseph County has seen a 700% increase in the use of heroin, and drug overdose deaths surpassed fatal car crashes and murders. This is not just a headline but a concern for all Hoosiers and especially healthcare professionals like dentists. According to IMS Health, National Prescription Audit in 2012, dentists are the fifth most frequent prescribers of opioids among healthcare providers in the United States. The most frequently abused opioids are immediate-release (IR) opioids, particularly hydrocodone and oxycodone. Dentists prescribe 12 percent of IR opioids in the United States, second only to family physicians, who prescribe 15 percent of IR opioids. This is why dentistry is concerned about its patients and the public and why it is good to remind ourselves of the best practices as we deal with prescriptions.  

Dentists’ Roles and Responsibilities

Dentists’ ability to prescribe comes from the Indiana State Board of Dentistry license, from the Indiana Pharmacy Board’s issuing of a Controlled Substance Registration (CSR) and from the Federal Drug Enforcement Agency (DEA) with scheduled drugs. A dentist’s authority to prescribe is limited to the scope of dentistry. Dentists cannot prescribe just anything to anybody. The prescription must be to a patient for the purpose of dental care. Indiana Senate Enrolled Act 226, which limits the amount of an opioid prescription a prescriber may issue under certain circumstances, became effective July 1, 2017. According to the law, opioid prescriptions written by dentists and other prescribers are limited as follows:

• If the prescription is for an adult who is being prescribed an opioid for the first time by the prescriber, the initial prescription may not exceed a seven (7) day supply.
• If the prescription is for a child who is less than eighteen (18) years of age, the prescription may not exceed a seven (7) day supply.

The legislation does allow for an increased prescription if, in the prescriber’s professional judgment, the patient’s condition requires a longer supply.  

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About the Authors

Mr. Jay Dziwlik, CAE, MBA, is the Indiana Dental Association Assistant Executive Director. He can be reached at Jay@INDental.org. Mr. Ed Popcheff is the Indiana Dental Association Director of Government Affairs. He can be reached at Ed@INDental.org.    

References

1. CNN online, US drug overdose deaths reach new record high, August 8, 2017, http://www.cnn.com/2017/08/08/health/drug-overdose-rates-2016-study/index.html
2. CNN online, “Opioid commission tells Trump to declare state of emergency”, August 1, 2017, http://www.cnn.com/2017/07/31/health/opioid-commission-emergency-declaration/index.html
3. Wish TV.com, “Indiana releases plan to fight drug epidemic”, May 18, 2017, http://wishtv.com/2017/05/18/indiana-releases-plan-to-fight-drug-epidemic/
4. South Bend Tribune, “Heroin pushes St. Joseph County overdose deaths pas murders, crashes”, February 5, 2017, http://www.southbendtribune.com/news/publicsafety/heroin-pushes-st-joseph-county-overdose-deaths-past-murders-crashes/article_a14700f8-e0a4-5553-94f4-9796a89f28d0.html
5. ADA Opioid prescribing info, http://www.ada.org/en/advocacy/advocacy-issues/prescription-opioid-abuse
6. CDC powerpoint on opioids giving to ADA https://www.fda.gov/downloads/Drugs/NewsEvents/UCM454826.pdf