Spring 2018

14 New Mexico Dental Journal, Spring 2018 Dental Prescribing Dentists made up 10% of all controlled substance prescribers and prescribed 4% of all controlled substance prescriptions filled in New Mexico in the first three quarters of 2017 according to data from the NM Board of Pharmacy Prescription Monitoring Program (PMP). However, they prescribed one half percent of the total morphine milligram equivalents (MME) of opioids dispensed. MME is a measure of the total volume of opioids that takes the different potencies of different opioids into account. Most dental prescriptions are short, with 87% having less than five days of supply and 98% having less than ten days of supply. Only 29% exceed 40 MME/day and only 7% exceed 60 MME per day. Most of the prescriptions over 60 MME per day were for only a few days, but allowed ten or more tablets per day. These prescriptions may lead to substantial amounts of left over drug. Doses of 60 MME/day or higher have been shown to be a risk factor for opioid overdose. Dental prescriptions may be the first exposure of young people to opioids and/or benzodiazepines, and research suggests that they may be prone to non-medical use of those prescriptions. Medication left over from prescriptions is a major source of drugs for non-medical use among younger people. Research has shown that combinations of nonsteroidal anti-inflammatory drugs (NSAIDS) and acetaminophen are more effective than opioids for the pain resulting from third molar extractions, without some of the side effects of opioids (Moore, P. A., & Hersh, E. V. (2013). Combining ibuprofen and acetaminophen for acute pain management after third-molar extractions. Journal of the American Dental Association, 144(8), 898–908). High risk opioid prescribing is relatively uncommon among dentists, but sometimes the combination of dental prescribing with other prescriptions that patients have can create risks. Dental prescriptions of opioids may inadvertently overlap other opioid or benzodiazepine prescriptions that patients have not disclosed. This creates a risk of overuse and perhaps overdose. Patients on medication assisted treatment (MAT) for opioid use disorder with buprenorphine or methadone are not good candidates for additional opioids, as the total dose may be too high. The Prescription Monitoring Program (PMP) at the Board of Pharmacy provides a tool to help ensure patient safety. It provides a way to evaluate a patient’s prior prescription controlled substance history and take that into account in deciding how to treat pain. It can be used to avoid inadvertent overlaps with other opioids or benzodiazepines which could compromise patient safety. Conclusions Prescription opioids have turned out to be far more problematic than advertised. They can be useful drugs for acute pain and cancer pain, but should not be the first-line treatment for chronic, non-cancer pain. Opioid prescribing should be done with careful consideration of the risks and benefits. Combinations of NSAIDs and acetaminophen appear to have lower risks and higher benefits than opioids, and so should be considered. Use of the PMP is an essential part of the careful prescribing of opioids. Youth & Rx Leftover prescription opioids and nonmedical use among high school seniors: a multi-cohort national study: https://www.safetylit.org/citations/index.php? fuseaction=citations.viewdetails&citationIds%5b%5d =citjournalarticle_387169_24&sha=1 Characterization of adolescent prescription drug abuse and misuse using the Researched Abuse Diversion and Addiction- Related Surveillance (RADARS®) system: https://www.safetylit.org/citations/index.php? fuseaction=citations.viewdetails&citationIds%5b%5d =citjournalarticle_389627_24&sha=1 continued from page 13