An overview and review of safe prescribing practices
Dentists at one time were in the
No. 2 spot for opioid prescribing
nationwide, just behind family
doctors. In 1998 we were the top
specialty prescribers of opioids for acute
pain, accounting for 15 percent of all
opioid prescriptions in the United States.
By 2012 this number had fallen to 6.4
percent. That is good news, as obviously,
efforts such as mandated education
and dental school curricula changes,
as well as the public attention being
paid to the epidemic, are having an
effect. But we can do better. A recent
study in Drug and Alcohol Dependence
estimated that, of the 100 million pain
pills prescribed by dentists annually,
more than half go unused. We have
been as much a part of the problem
as any health care professional group.
Death from opioid and other substance
use disorders knows no socio-economic
class, race, creed, profession or gender.
It is a disease that offers no option but
to seek relief in drugs or alcohol, and
arguably is never truly cured. The stories
of addiction and misuse one can read
every day are similar, emotionally
draining, and routinely sad. Addiction
destroys individual lives, tears the family
fabric, and affects whole communities.
We, as health care professionals, have a
responsibility to our patients to be well
informed about opioid addiction and
appropriately use pain medication for
maximum benefit and minimal adverse
effects.
According to the CDC, from 1999 to
2016, more than 200,000 people died
in the United States from overdoses
related to prescription opioids. Overdose
deaths involving prescription opioids
were five times higher in 2016 than in
1999. We also know that 94 percent of
heroin addicts began their addiction
with either prescribed or diverted
opioid pills.
Philadelphia had the second-highest
rate of drug overdose deaths in 2016
among the nation’s 44 counties with
over 1 million residents: 46 per 100,000
residents, with most attributed to the
misuse of opioids. Only Allegheny
County, which includes the city of
Pittsburgh, had a higher rate.
Nationally, the 2017 rate topped 72,000
lethal drug overdoses, which means
now, in a period of two years, more
people have died of opiate addiction
than in the entire Vietnam war, or put
another way,
174 PEOPLE DIE
every day from drug
overdoses in the U.S.,
and 15 people per day
in Pennsylvania.
According to the CDC, sales of prescription
opioids in the U.S. nearly quadrupled
from 1999 to 2014, but there has not
been an overall change in the amount
of pain Americans report. One could
argue that the widely available supply
“found” people susceptible to addiction.
The statistics are increasing in no small
part due to the entry of fentanyl and
related substances into the population.
In 2014, Philadelphia’s heroin averaged
65 percent purity, the highest in the
country among all samples tested.
Based on national data showing that
20 percent of heroin users seek or
participate in treatment for their heroin
use, it is estimated that there are at least
70,000 heroin users in Philadelphia.
This is a conservative estimate, as it
does not include individuals who may
have obtained care in the private
treatment system. The economic cost to
Pennsylvania in terms of lost productivity,
increased crime, and adverse health
consequences was estimated at $53
billion in 2016, as compared to about
$8 billion in 2007.
In 2017 Pennsylvania also achieved the
dubious honor of being the third
highest state in overdose deaths, at
44/100,000. A total of 5,643 people died
in 2017 in the Commonwealth, an
increase of 18 percent over 2016. Only
West Virginia and Ohio have higher
rates. As an example, in Ohio you can
get heroin delivered faster than pizza.
And addicts in New Orleans are now
bringing in hurt dogs and cats in hopes
of getting narcotics.
JAN UARY/FEBRUARY 2019 | P EN N SYLVAN IA DEN TAL JOURNAL
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