An overview and review of safe prescribing practices
A final thought: In my oral surgery
GUIDELINES ARE AS FOLLOWS:
1.
Complete history prior to initiating pain therapy.
2. Use NSAIDS as a first line analgesic therapy.
3. Use Acetaminophen as a synergistic medication.
4. Use local (long-acting) anesthetics whenever possible.
5. If using an opioid, choose the lowest possible dose for the
shortest possible duration.
6. Use the mandated PA PDMP to determine concomitant
medications.
7.
Use care in prescribing for those on benzodiazepines and
sleep apnea.
OTHER GUIDELINES:
a. Prescribe for legitimate dental purposes only
practice, I have all but stopped pre-
scribing opioids for any type of surgery
over the past two years. By calling all
of my post-operative patients the day
after their surgery for the past 32 years,
it has become clear that narcotics are
not needed to treat acute pain for the
vast majority of patients.
However, some patients do need
more than non-opioid pain control,
and stopping prescribing altogether is
a simple answer to a complex problem,
which does have the potential for
undertreating pain. But if you try the
strategies and recommendations
described here, I am sure you will find
yourselves writing a lot fewer prescrip-
tions and thinking instead of the much
safer and efficacious alternatives.
b. Prescribe for patients of record only References and Relevant Web Sources
c. Review medical history prior to prescribing, as NSAIDs and/or
Acetaminophen may not be appropriate for some patients. 1. Association of Opioid Prescriptions from Dental
Clinicians for US Adolescents and Young Adults
With Subsequent Use and Abuse: JAMA Intern Med.
Published online 12/3/18
2. Association of Opioid Prescribing With Opioid
Comsumption After Surgery in Michigan: Howrd,
Fry, Gunaseelan, et al. Jama Surg. Published online
11/7/18.
3. McCarthy D. Reducing Inappropriate
Medication Use by Implementing
Deprescribing Guidelines. Cambridge, Massachusetts:
Institute for Healthcare Improvement; 2017.
4. Substance Use Disorders: Wiley Blackwell 2015: ADA
publication www.ada.org and ada.org/opioids
5. America’s War on Pain Pills is Killing
Addicts and Leaving Patients in Agony: Reason.com
April 2018
6. Centers for Disease Control and Prevention: multiple
publications. www.cdc.gov
7. American Society of Addiction Medicine (ASAM) 2016;
NHHS Statistics 1999-2016. https://www.asam.org/
8. www.cdc.gov/drugoverdose/prescribing/guideline.html
9. www.opioidprescribing.org
10. www.drugs.com
11. www.streetdrugs.org
12. www.aidscaregroup.org
13. https://conversation.zone/
14. https://drugfree.org
15. https://www.drugabuse.gov/
16. https://www.samhsa.gov/
17. www.health.pa.gov/topics/disease/
Opioids/Pages/Opioids.aspx
d. Always assess as best you can the need for opioids
e. Counsel and follow up with patients regarding proper compliance,
security, storage and disposal
f. Train office staff to check PDMP
g. Never prescribe without proper treatment
h. Safeguard prescription pads or go digital
i. Start with 600-800mg of ibuprofen combined with 500-1000 mg
acetaminophen. Example: 3 Advil plus 1 extra strength Tylenol every
4-6 hours.
Assess patient response. If above is not sufficient: Prescribe minimal
amount of a narcotic e.g. 4-6 Hydrocodone (Vicodin 5mg or 7.5mg/325)
e.g. one every 4-6 hours
Re-assess and only prescribe more ONLY if you see the patient beforehand
j. Be aware of subjective nature of pain.
k. Consider alternative NSAIDs such as Ketoprofen (Orudis), Etodolac
(Lodine), or Ketolorac (Toradol).
JAN UARY/FEBRUARY 2019 | P EN N SYLVAN IA DEN TAL JOURNAL
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