Turning the Tide of Opioid Addiction
Billions ( constant 2016 dollars )
CURRENT STATE
$ 200
$ 150
$ 100
$ 50
$ 0 2001
Local Governments
Costs of the Opioid Epidemic by Year and Payer
$ 29.1
$ 48.7
State Governments
Projected burden at current rates
$ 60.9
$ 95.8
2006 2011 2016 2020
Federal Governments
$ 199.9
* Data between labeled estimates interpolated using constant growth rates
Individuals and Private Sector
There have been some efforts at combatting the opioid crisis that have emerged throughout the medical profession . However , these have not resulted in any meaningful impact for communities and definitely not for patients and their families . A stronger , more comprehensive strategy is required to aggressively , yet safely , tackle pain management without endangering those we are sworn to serve . Our oath dictates that we first “ do no harm .” This includes what we prescribe in our effort to help . We cannot – should not – be oblivious to the consequences of our actions as prescribers .
METHODS AND EXPERIENCE at the University of Pittsburgh School of Dental Medicine
As Dean of the University of Pittsburgh School of Dental Medicine , I believe that prudent pain education and treatment policies begin in the curriculum . Without a sensible policy for training future clinicians , a “ just in case ” opioid prescription approach perpetuates the devastating statistics that are otherwise be preventable .
Like many institutions , it was common practice to prescribe opioids for a variety of painful procedures . That protocol came into question when a challenge was issued that made me change my thinking . While we would normally issue an opioid prescription for a youth ’ s wisdom teeth extraction , the patient ’ s mother , a public health expert , asked about the necessity of such a strong script . This brought a new focus to considering what medications could work equally well . At my direction , one trainee completely stopped issuing opioids to almost all of my patients with absolutely no negative outcomes . Yet , appropriate pain control was achieved . That one , very simple question led to crafting the Costello Guidelines for Prescribing Pain Medications , which has been 100-percent successful in managing pain , while simultaneous avoiding potentially addictive narcotics .
At Pitt ’ s School of Dental Medicine , we were the first institution in the nation to have successfully adopted an alternative approach we now characterize as “ break-glass-only-in-case-of-emergency ,” thereby significantly decreasing the amount of opioids prescribed ( rather than a “ just in case ” tactic ). The results for our patients : absolutely no deleterious consequences for those we serve . In its first year of implementation , we achieved a 54.3-percent decrease in the prescription of opioids , despite a massive increase in our
16 MARCH / APRIL 2022 | PENNSYLVANIA DENTAL JOURNAL