Opioid Use in the Dental & Oral Surgery Field

Surgical procedures, including third molar extractions are common procedures in which opioid-naïve patients, especially adolescents, are first exposed to opioids. While dentists and oral surgeons strive to compassionately manage patients’ pain, they must do so responsibly to curtail long-term use and misuse, as well as minimize potential diversion from large amounts of leftover prescription opioids. This is especially important among adolescents who are at heightened risk of future opioid misuse.

Many oral and maxillofacial surgery training programs are revising their acute postoperative prescribing protocols to decrease the number of opioids prescribed and promote use of non-opioid alternatives for pain management. Education for providers is essential to changing pain management protocols and mitigating risk of opioid misuse. Education, coupled with open communication with patients to set appropriate expectations and treatment goals, presents an opportunity to optimize clinical outcomes and improve patient satisfaction.

Putting Pressure on Opioid Prescribing: Novel Approaches to Pain Management

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Opioids continue to impact all corners of the United States and its communities, a burden that continues to grow at a rapid pace. The current opioid crisis is incredibly challenging for both patients and health care providers (HCPs). There has been a 30% increase in overdoses among men and a 24% increase among women, with all ages affected. While changing these current trends is important, it cannot be accomplished by policy changes alone. There is no one size fits all model for communities to address this crisis.  This activity is also available as a podcast>>

Time To Listen: What The Experts Have To Say About Safe Opioid Prescribing And Addiction Treatment

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This CME Outfitters activity features insight from this panel of experts on the challenges, consequences, and opportunities for the development of education to help meet the pain management needs of patients amid rising concerns of addiction and diversion.

 

Addressing the Opioid Epidemic: Reducing the Burden of Pain in a Changing Treatment Landscape

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Developing actionable steps to promote appropriate prescribing for individuals with acute and chronic pain is imperative to curbing the impact of the growing opioid crisis facing our communities.

Addressing the Opioid Epidemic: New Approaches to Safe and Effective Pain Management

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In part 2 of this 3-part series, expert faculty focus on the four-step approach that follows the SOAP (Subjective-Objective-Assessment-Plan) approach to pain management, as well as principles of communication with patients experiencing pain in order to help clinicians appropriately prescribe the best therapy for pain management in each patient.

Addressing the Opioid Epidemic: Principles of Communication and Recognizing Patient Needs


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The conclusion of this 3-part series features expert faculty focusing on a collaborative patient-centered approach in order to guide optimal pain management, which includes applying an evidence-based approach to chronic pain management and improving prescribing practices through pharmacovigilance.

Shifting Perspectives on Pain Management in Oral Surgery

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In a survey of 1,015,116 opioid naïve patients undergoing surgery, total duration of opioid use was the strongest predictor of misuse and the greatest risk for individuals in the 15-24 age group. Young people aged 15-24 often get their first exposure to opioids with dental surgery. In a survey of randomly selected oral surgeons conducted by Dr. Abubaker and colleagues, the average number of opioid tablets prescribed was 20, with 22% prescribing more than 20 tablets, and 11% prescribing more than 30 tablets. These risk factors, combined with the current epidemic, has led many oral surgeons to believe that the old standards of depending on opioids as a first-line treatment should be a thing of the past. In this free CME Snack, Dr. Gold and Dr. Abubaker share insights on alternative pain management strategies for oral pain with a focus on finding a balance between compassion for patient care and patient safety.  This activity is also available as a podcast>>

Addressing the Opioid Epidemic: A Call to Action to Save Our Communities

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Join Dr. Gold and Dr. Stanos in augmented reality illustration of pain management strategies to optimize safe and responsible management of acute and chronic pain.  This activity is also available as a podcast>>

It Starts with a Signal: Understanding Pain, Addiction, and Treatment

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The number of opioid related deaths in the US is on the rise and health care providers often struggle finding a balance between prescribing guidelines and the individual needs of patients with acute and/or chronic pain. Meeting the needs of patients begins with an understanding of the mechanisms of pain and addiction. In this 4-part activity certified for dental credit, faculty explain the connection between pain mechanisms and treatment decisions, and the importance of understanding the role of gender in pain and addiction.  This activity is also available as a  podcast>>

A Change of Plans: Adjusting Treatment and Prescribing Methods to Address the Opioid Epidemic

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Shifts in approaches to acute and chronic pain management that integrate biopsychosocial strategies and non-opioid medications require education for all stakeholders—clinicians and patients—to achieve success. This 3-part series about responsible prescribing for pain management will arm you with best practice strategies to implement in practice today.  This activity is also available as a podcast>>

Championing Change: Addressing Addiction in Our Communities

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In this CME Snack, Jessica Nickel, founder of the Addiction Policy Forum, and Dr. Mark Gold focus on community-based strategies to provide an effective care settings for those dealing with substance use disorder.  This activity is also available as a podcast>>

Naloxone to Reduce Overdose Mortality White Paper

A Way Forward: How Naloxone Saves Lives from Opioid Overdose

Increasing access to naloxone is essential to reducing overdose mortality. Strategies for increasing access must be thoughtfully developed and deployed to ensure that naloxone is available to any at-risk individual—whether that be an individual with chronic pain or someone with a substance use disorder—without the burden of stigma or judgement. CMEO convened an expert panel led by Dr. Mark Gold to discuss barriers and opportunities for distribution of naloxone to those at risk for overdose in the community. This white paper, A Way Forward: How Naloxone Saves Lives from Opioid Overdose reviews the data used by the panelists to establish their positions and recommendations for the way forward.

Conducting an ePain Assessment: Asking the Right Questions, Using the Best Tools

Participate NowCase-based learning is helpful in illustrating not just strategies for managing challenging patients, but also in sharing experiences and insights on maintaining quality care when facing changes in clinical workflow. To help clinicians adapt to virtual appointments, part one of this CME Outfitters BriefCase series features expert faculty presenting a case vignette that demonstrates tips for performing psychosocial and physical assessments via a telehealth appointment in order to educate clinicians on appropriate management of pain and the viability of Telehealth for pain evaluation and ongoing management

Are You Seeing the Big Picture?: A Multimodal Approach to the Management of Pain

Participate NowPart two of this CME Outfitters BriefCase series revisits the patient case from part one, with a focus on how best to handle prescribing, patient education, and shared decision-making via telehealth appointments.

Opioid Red Flags: Examining the Options and Taking the Next Steps

Participate Now The final episode of this CME Outfitters Briefcase series focuses on identifying the red flags of OUD and best options for taking the next steps to engage patients and develop appropriate treatment strategies.

Rethinking Standing Orders for Opioids to Manage Pain in Adolescents and Young Adults Requiring Third Molar Extraction

Participate NowIt has long been a habit of dentists and oral and maxillofacial surgeons to prescribe narcotics following surgeries such as third molar extraction, with many prescribing as many as 20-30 tablets.A recent study of 105 patients who underwent third molar extraction saw 8 surgeons prescribing 1,773 opioid units, with only 38.4% of those units being consumed during the study period. The first installment of this CME Outfitters Briefcase series on non-opioid pain management focuses on how to choose safe and effective pain management strategies for dental postsurgical pain by aligning pain management practices to evidence-based recommendations for a rational, multimodal approach to analgesia.
Resources

An Animated Look at Acute and Chronic Pain Pathways – Download the Animation Guide here (PDF)

Download Animated Look at Acute and Chronic Pain Pathways Video

Understanding Pain Pathways

Download Understanding Pain Pathways Video

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Schroeder AR, Dehghan M, Newman TB, Bentley JP, Park KT. Association of opioid prescriptions from dental clinicians for US adolescents and adults with subsequent opioid use and abuse. JAMA Intern Med. 2019;179(2):145-152. Read it here

Tompach PC, Wagner CL, Sunstrum B, Nadeau RA, Tu HK. Investigation of an opioid prescriber protocol after third molar extraction procedures. J Oral Maxillofac Surg. 2019;77:705-714. Read it here

Mutlu I, Abubaker AO, Laskin DM. Narcotic prescribing habits and other methods of pain control by oral maxillofacial surgeons after impacted third molar removal. J Oral Maxillofac Surg 2013;71(():1500-1503. Read it here

Al-Khteeb TH, Alnahar A. Pain Experience After Simple Tooth Extraction. J Oral Maxillofac Surg. 2008;66(5):911-917. Read it here

Overton HN, Hanna MN, Bruhn WE, et al. Opioid-prescribing guidelines for common surgical procedures: an expert panel consensus. J Am Coll Surg. 2018;227(4):411-418. Read it here

Brainstorming Opioid Addiction through Merged Perspectives: Learnings from Roundtable Discussions


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According to the National Institute on Drug Abuse, 115 people die each day in the United States due to an opioid overdose. To better understand the nation’s current epidemic, CME Outfitters recently brought together the perspectives of those most impacted by opioids in hopes of creating more effective strategies to avoid addiction in the coming years. These roundtable discussions, hosted by CME Outfitters, first pulled the experiences of both patients and their loved ones who have been affected by opioid dependency. Read more about the the four key takeaways that we learned.

From Analytics to Understanding: A Look Into Our 3D Pain Animation’s Debut at CME Outfitters’ Opioid Epidemic Premiere Symposium

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Family medicine providers are uniquely qualified to lead the charge for precise and responsible prescribing for acute and chronic pain. Family medicine is at the forefront of managing chronic illness, handling comorbidities, and coordinating care for their patients. A recent live meeting held at the Pennsylvania Academy of Family Physicians (PAFP) used an animated 3-D model that learners were able to move, rotate, and zoom as they explored acute and chronic pain pathways.