drug abuse
Recommendations for Co-Prescription of Opioids and Naloxone in the Dental Office Madeleine Maas, D.D.S.; Raquel Rozdolski, D.M.D.
On Dec. 29, 2021, Gov. Kathy Hochul signed a bill into law in New York State, with bipartisan support, that will require medical professionals to co-prescribe naloxone (an opioid antagonist) along with an opioid prescription when certain patient risk factors are present. This law will require practitioners to have important conversations with their patients when they consider the prescription of an opioid to determine if the patient has a history of substance-use disorder. Additionally, practitioners must prescribe naloxone when patients are prescribed high-dose or cumulative prescriptions that equate to 90 morphine milligram equivalents or higher per day or who are also taking concurrent opioids, benzodiazepines or nonbenzodiazepine sedative hypnotics. This law takes effect 180 days from the date it was signed into law. As authors of the article “Recommendations for the Co-Prescription Opioids and Naloxone in the Dental Office,” which first appeared in 2020 in ADSA Pulse, the newsletter of the American Dental Society of Anesthesiology, both Dr. Madeleine Maas and I applaud the strides New York State is taking in the opioid epidemic.
18
MARCH 2022
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The New York State Dental Journal
IN THE PAST, opioid analgesics were prescribed frequently as the first line of pain management after dental procedures and though nonsteroidal anti-inflammatory drugs have risen to the top, opioids are still commonly prescribed. Historically, opioid analgesics, while an important tool in pain management, are associated with high rates of abuse, misuse and addiction. In the United States, drug overdose deaths continue to rise and this trend is largely driven by prescription opioid analgesics.[10] In fact, 5 percent to 23 percent of all prescription opioid doses dispensed are used for non-medical purposes.[5] Though primary care physicians prescribe the bulk of opioids, certain specialties, such as dentistry, prescribe opioids at a higher rate.[10] All prescribers have a responsibility to minimize the potential for drug abuse, misuse, addiction and overdose while still prescribing necessary opioids for patients in need of such opioid analgesia.[5] Some physicians have already begun co-prescribing naloxone, along with opioids, to minimize that risk. However, this practice is not currently common within the dental profession. Providing overdose prevention in the form of naloxone and opioid overdose response education, including assessment and stimulation of the victim, administration of naloxone, basic life support and aftercare to drug users, their friends and family can save lives. It is the dental provider’s responsibility to respond to this call and stay informed on alternative forms of pain management and to know when and how to prescribe opioids safely to their patients. This paper will list and discuss several factors related to the decision concerning prescription of opioids and the co-prescription of naloxone. It will also attempt to provide a guideline for such prescriptions. Reprinted with permission from March 2020 ADSA Pulse, newsletter of the American Dental Society of Anesthesiology.
