abuse is a serious public health issue in the United States. Results from the 2016 National Survey on Drug Use and Health (NSDUH) indicate that 3.3 million people over age
12, and an estimated 239,000 adolescents aged 12 to 17, abused prescription
pain relievers in 2016. Common prescribers of opioids—internal medicine
physicians, primary care physicians and dentists—must have ready access to the
tools and resources required to identify and address addiction problems with
“We need all the health professions working together to have the effect we want on the opioid epidemic,” says Denice Stewart, D.D.S., ADEA Chief Policy Officer, in her opening remarks at the Dental Schools Addiction Education Summit for SAMHSA Regions III and IV* held on Aug. 30 in Washington, DC.
ADEA and the
Substance Abuse and Mental Health Services Administration (SAMHSA) co-hosted meeting centered on the opioid epidemic and the role academic dentistry can play in addiction prevention. Dental school representatives from 17 dental schools in 11 states
and the District of Columbia attended the meeting, alongside representatives from state agencies; federal agencies, including SAMHSA, the Health Resources and Services Administration (HRSA), and the Uniformed Services University of the Health Sciences (USUHS); and stakeholders such as the American Dental
Association (ADA) and the Association of American Medical Colleges (AAMC).
The summit offered an intentional mix of educational presentations and interactive sessions. Melinda Campopiano, M.D., Senior Medical Advisor at SAMHSA, talked about the scope of the opioid addiction problem in the United States and the importance of educating
prescribers in substance abuse prevention. She provided several strategies that academic dental institutions could employ to help reduce drug addiction.
First, she urged dental schools to view prescription drug monitoring programs (PDMPs) as patient safety tools, advising that faculty and students use them before prescribing any pain medications. She said many providers only use PDMPs when they suspect a patient
of substance misuse, which limits the tool’s effectiveness. Second, she recommended educating students about
Screening, Brief Intervention and Referral to Treatment (SBIRT), and establishing referral relationships with addiction treatment providers and social services programs in the community. Third, she suggested that dental schools tap into “academic
detailing” resources in their states and invite health care professionals knowledgeable about addiction to talk to students and faculty.
Dr. Campopiano also noted that common barriers to incorporating screening for addiction problems into practice include lack of education, resources, time, perceived roles and negative attitudes. Providers often feel uncomfortable discussing alcohol, drug and
prescription use with their patients. Reimbursing dentists for using SBIRT might help address this issue. Additionally, toothaches and oral infections funnel people into ERs and support inappropriate use of antibiotics and pain medication prescribing by ER providers. She concluded her presentation by saying
that the dental profession has an opportunity to provide input and recommendations on this issue to the
President’s Commission on Combating Addiction and the Opioid Crisis.
Following Dr. Campopiano’s presentation, dental school representatives briefly presented their academic institutions’ current activities to address the opioid epidemic. Activities varied, with the most common including incorporating pain management, addiction
and prescribing information into lectures and clinical experiences; using PDMPs; educating faculty about addiction and prescribing practices; collaborating with other health professions to learn about addiction; and using SBIRT.
Other stakeholders then presented their activities. State-level activities included developing opioid and prescribing guidelines, strengthening PDMPs, having statewide conversations, and developing state strategic plans to address the opioid issue. The ADA has an informational
website, is offering free one-hour CE webinars, and has a list of volunteer dentists who are in recovery willing to talk to students and faculty. AAMC has been working with medical schools on this issue, from policy to curricular development. They
are concluding a survey to better understand medical schools’ curricular needs regarding the opioid epidemic. The AAMC
website summarizes the organization’s activities. HRSA reported that the opioid epidemic is an agency priority, and they recently awarded
$200 million to health centers nationwide to tackle mental health and fight the opioid overdose crisis. The USUHS medical school implemented a pain management curriculum—the first medical school in the nation to do so.
Next, Ronald Kulich, Ph.D., of the Craniofacial Pain Center at Tufts University School of Dental Medicine (TUSDM), described the sweeping
initiative in Massachusetts to address the opioid addiction problem. In 2016, the Massachusetts Governor’s Dental Education Working Group on Prescription Drug Misuse produced dental education
core competencies for the prevention and management of prescription drug misuse. Leaders from the three dental schools in the state (Boston University Henry M. Goldman School of Dental Medicine, Harvard School of Dental Medicine, and Tufts University School of Dental Medicine) were
integral in establishing these competencies and implementing changes within their institutions.
The competencies’ goals are to help dental students gain a strong foundation in prevention, identify substance use disorders, manage the complex patient requiring effective pain management and refer patients for appropriate treatment. The curriculum stresses
assessing, counseling, treating and reassessing the patient. “No one is suggesting that [dentists] should not write [prescriptions for] opiates,” Dr. Kulich says. “What we are suggesting is there should be rational prescribing.” Watch Dr. Kulich’s
The cross-institutional competencies will reach approximately 1,800 enrolled undergraduate dental students and 580 advanced graduate dental students across Massachusetts. Each dental school will tailor the core competencies to its curricula.
Following Dr. Kulich’s presentation, Steven Moriconi, D.M.D., Chief of the Dental Division at Abington Hospital – Jefferson Health, described how he has altered his prescription protocols after dental surgery in his practice. His approach included considering non-opioids as a first line, using the PDMP, and
close advance review of patients’ medical histories. He establishes rapport with a patient and their family, explaining what to expect from the procedure and pain management afterward, and then calls the patient the next day to see how they are doing and what pain medications they took. He cautioned providers
to be mindful of patients who are in recovery from addictions—it takes only one dose to start them back on the addiction road. He also recommended prescribing opioids for legitimate purposes only, and only to patients of record.
Dr. Moriconi concluded by saying academic dental institutions need to educate their faculty about opioid abuse, so they in turn can teach students. “What students learn in school is what they carry into practice,” he says.
Next, the participants, grouped by geographic location, held small group discussions to describe one practical idea they wanted to implement to improve addiction awareness in their academic dental institutions. Ideas presented include:
- Teach faculty about best practices for prescribing opioids as a first step in teaching students.
- Create a toolkit for prescribing dentists that includes patient education handouts.
- Use an interprofessional approach to increase students’ competencies, knowledge and practice around opioid prescribing.
- Expand mandatory opioid education nationwide, and offer continuing education for everyone that prescribes.
- Form a task force on opioids as part of a curriculum committee that is revising the dental school curriculum.
- Collaborate with other dental schools in the state to create a plan/module for educating students about opioid prescribing and addiction.
- Establish baseline information about prescribing patterns, including all dental and advanced dental education programs, with an emphasis on pain and anxiety control.
- Create an integrated substance abuse education program, implement SBIRT, develop competencies and assess those competencies.
At the end of the summit, SAMHSA and ADEA staff devised a plan to sustain momentum and talked about next steps. The plan is to continue the conversation with the dental schools within SAMHSA Regions III and IV, and to share information between and among dental
schools from other regions. Proceedings from the meeting will be made available upon release from SAMHSA. Additional programs on this topic are being planned, including an educational session at the 2018 ADEA Annual Session & Exhibition in Orlando.
*SAMHSA Region III includes Delaware, the District of Columbia, Maryland, Pennsylvania, Virginia and West Virginia. SAMHSA Region IV includes Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina and Tennessee.
Published on October 11, 2017