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Dentist Perception on Opioid Risk and Use in Acute and Chronic Pain

Dentist Perception on Opioid Risk and Use in Acute and Chronic Pain. Inciardia JA, et al. The Diversion of Prescription Drugs by Health Care Workers In Cincinnati Ohio. Substance Use & Misuse, 41:255–264.

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Dentist Perception on Opioid Risk and Use in Acute and Chronic Pain

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  1. Dentist Perception on Opioid Risk and Use in Acute and Chronic Pain

  2. Inciardia JA, et al. The Diversion of Prescription Drugs by Health Care Workers In Cincinnati Ohio.Substance Use & Misuse, 41:255–264

  3. Table 1 Selected characteristics of 423 cases of prescription drug diversion by health care workers in Cincinnati, Ohio, 1992–2002. * In 2002 there were 6,132 dentists licensed to practicein Ohio. 5/6132 = 0.04% Inciardia JA, et al. The Diversion of Prescription Drugs by Health Care Workers In Cincinnati Ohio. Substance Use & Misuse, 41:255–264

  4. Table 2. Drugs diverted by health care workers in Cincinnati, Ohio, 1992–2002 Inciardia JA, et al. The Diversion of Prescription Drugs by Health Care Workers In Cincinnati Ohio. Substance Use & Misuse, 41:255–264

  5. CASE: A neighborhood pharmacist became suspicious when she filled a hydrocodone prescription for a 17-year-old. The pharmacist called the youth’s mother and found that she was unaware of her son’s prescription or his visit to the dentist. The pharmacist then called the police, and during the investigation, it was found that the dentist had written dozens of hydrocodone prescriptions in his assistant’s name, and in the teenager’s name as well. Both were filling them at different pharmacies around town. The tablets were being split with the dentist, who was a hydrocodone addict, as were the assistant and the 17-year-old. Inciardia JA, et al. The Diversion of Prescription Drugs by Health Care Workers In Cincinnati Ohio. Substance Use & Misuse, 41:255–264

  6. Underwood B, Fox K. A survey of alcohol and drug use among UK based dental undergraduates. Br Dent J. 2000 Sep 23;189(6):314-7. • Study: • 1. Investigate the prevalence of alcohol and drug use. • 2. Anonymous self-report questionnaire. • 3. A UK dental school in May 1998. • 4. Subjects: 1st-5th year dental students (n = 264) • 5. Questions on use of EtOh, cannabis & other illicit drugs. • Results: • 82% males & 90% females while at school reported EtOH use. • 2. Of these, 56% males & 58.5% females report binge drinking. • 3. 55% students reported cannabis use at dental school. • 4. 8% males & 6% females report current cannabis use 1/week. • Conclusion: • Dental students (>56%) engage in drinking above sensible weekly limits of alcohol, binge drinking and indulging in illicit drug use.

  7. Kenna GA, Wood MD. The prevalence of alcohol, cigarette and illicit drug use and problems among dentists. JADA. 2005 Jul;136(7):1023-32. Study:1. Investigate the prevalence of alcohol and drug use. 2. Anonymous 7 page self-report questionnaire.3. Northeastern state in the USA conducted in 2002.4. Subjects: 113 dentists and 104 physicians (65% and 63% respectively)5. Questions on use of EtOh, cannabis and other illicit drugs.Results: 1. Twice as many physicians as dentists reported heavy alcohol use2. However, more dentists reported heavy episodic alcohol use recently and reported having more alcohol-use problems than physicians. 3. Twice as many physicians reported using anxiolytics than did dentists. 4. More dentists than physicians reported minor opiate use in the past-yearConclusions:The prevalence data collected in this study suggests that dentists are equivalent to physicians regarding their risk of developing alcohol- or other drug-use problems.

  8. Underwood B, Hackshaw A, Fox K. Smoking, alcohol and drug use among vocational dental practitioners in 2000 and 2005 Study1. investigate prevalence of alcohol and drug use among UK dentists in 2005.2. Compare with the prevalence data from 2000.3. Survey using an anonymous self-report questionnaire.4. Subjects were all 767 dentists who started practice in summer of 20045. Questions on tobacco, alcohol, cannabis and other illicit drugs used.Results1. 502 subjects responded in 2005 and 534 subjects responded in 2000.2. 82% of males and 81% of females reported alcohol use (down 7%)3. Reported binge drinking remained high, 44% of males and 39% of females.4. 38% males & 26% females reported current cannabis use (same in 2000)5. Reported use of illicit drugs other than cannabis was less than in 2000. Conclusion:This study has found the level of alcohol, tobacco and illicit drug use (excluding cannabis) among new dentists decreasing since 2000, but levels of binge drinking and cannabis use remaining similar.

  9. Bhamba B, et al., Survey of select practice behaviors by primary care physicians on the use of opioids for chronic pain. Curr Med Res Opin. 2006 September ; 22(9): 1859–1865. Table 2. Practice approaches to narcotic prescribing (N = 248) Yes: n (%)

  10. Clark, GT. Survey of select practice behaviors by primary care Dentists on the use of opioids for chronic pain. (pilot data, unpublished) Table. Practice approaches to narcotic prescribing (N = 17) All Generalists with average of 21.7 years of practice experience. Yes: n (%)

  11. Bhamba B, et al., Survey of select practice behaviors by primary care physicians on the use of opioids for chronic pain. Curr Med Res Opin. 2006 September ; 22(9): 1859–1865. Table 3. Reasons for Physician concerns about prescribing opioids for chronic pain (N = 248)`

  12. Clark, GT. Survey of select practice behaviors by primary care dentists on the use of opioids for chronic pain. (pilot data, unpublished) Table. Reasons for Dentist concerns about prescribing opioids for chronic pain. All Generalists with average of 21.7 years of practice experience. (N = 17)

  13. Bhamba B, et al., Survey of select practice behaviors by primary care physicians on the use of opioids for chronic pain. Curr Med Res Opin. 2006 September ; 22(9): 1859–1865. Table 4. Physician comfort with prescribing narcotics for different pain conditions (N = 248) [USING A 1-10 SCALE] Total (n = = 241) ; Note: Scale = 1–10, where 1 = not at all comfortable, to 10 = very comfortable

  14. Clark, GT. Survey of select practice behaviors by primary care dentists on the use of opioids for chronic pain. (pilot data, unpublished) Table. Dentist comfort with prescribing narcotics for different pain conditions (N = 17). All Generalists with average of 21.7 years of practice experience. [USING A 1-10 SCALE] Total (n = = 241) ; Note: Scale = 1–10, where 1 = not at all comfortable, to 10 = very comfortable

  15. Significant Diversion CasesThe San Diego Regional Pharmaceutical Narcotic Enforcement Team (RxNET) conducted 16 investigations which resulted in 16 arrests during January and February. The arrests were for 11173(a) H&S, Obtaining a controlled substance by fraud; 459(b) PC, commercial burglary; 11351 H&S, possession for sale of a specific controlled substance; 4059 B&P, furnishing dangerous drugs without a prescription; and 3056 PC, parole violations. The predominant drugs of abuse were Vicodin, Codeine compounds, and Xanax.-------------------------------------------------------------------------------------------------------Los Angeles BNE Diversion is continuing its large-scale investigation into a Southern California doctor that has been overprescribing Oxycontin and other opiate-based pharmaceuticals. In a ten month period, one pharmacy conducted $2.4 millon in sales of the prescriptions from the doctor. There have been deaths attributed to the overprescriptions. This case is being investigated with the Medical Board, Pharmacy Board, Medi-Cal Fraud, and the Ventrua County Sheriff’s Homicide Unit.

  16. Balevi B, Breen L, Krasnowski J. The dentist and prescription drug abuse. J Can Dent Assoc. 1996 Jan;62(1):56-60. Study:1. Discussion of issues on Rx drug abuse for dentists.2. List of methods used by drug seeking individuals (DSI).Results:1. forgery is one method2. verbal misrepresentation of symptoms3. multiple doctor seeking Conclusions: The diversion of such drugs can produce a very high rate of return for DSIs, with only a minimal risk of arrest and conviction. Prevention takes prudent prescribing & double checking all patient facts.

  17. Inciardia JA, et al. The Diversion of Prescription Drugs by Health Care Workers In Cincinnati Ohio. Substance Use & Misuse, 41:255–264 Conclusion: Important research needs include a better understanding of:1. The magnitude of diversion;2. The myriad of ways that drugs are diverted;3. The mechanisms through which diverted drugs are ultimately reaching the streets;4. Engage the ADA and the AAOP in a collecting a survey like the Bhamba et al. study on opioid use in DDS offices and specialists who tx chronic Pain;5. Survey the Pharmacology teachers in dental schools (and graduate programs) about opioid use and abuse; 6. Support innovative educational training methods (interactive 3-D immersion) for managing DSI’s.

  18. Thank youDr. Glenn Clark

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