Spring 2018

24 New Mexico Dental Journal, Spring 2018 NMBDHC REPORT Opioids in Clinical Practice…A 30 Year Perspective By L. Paul Balderamos, DDS, MS, FACP— Vice-Chairman New Mexico Board of Dental Health Care I wrote my first prescription for an opioid to help a patient manage odontogenic pain when I was a third year dental student. The prescription had to be countersigned by a faculty member who insisted that I spend what seemed an inordinate time counseling the patient about opioids. Biochemistry, mechanism of action, dosage, toxicity and dangers of addiction all had to be addressed. The patient eventually rolled her eyes and stated “I am not a child! All I need is a little help!” In my General Practice Residency, a representative of a pharmaceutics company brought post it notes to our hospital clinic. The notes were in the shape of a telephone and had a logo….”LORTAB…NOW JUST A PHONE CALL AWAY.“ In practice, it was acceptable to call in 20 pills for dental pain and indeed we were encouraged by drug company representatives to make a pain control prescription a part of our standard of care in the hospital ER. One of my fellow residents quipped, “I give 20 Vicodin whenever I extract teeth. Eventually the patient will run out of teeth and will not be able to get more Vicodin.” In the early years of my practice I received a glossy flyer; “GREAT NEWS! Vicodin can be purchased in 1000 pill batches! You can dispense smaller doses out of your office to help out your patient, avoid the hassle of a trip to the pharmacy and charge the patient a prescribing fee which may be covered by insurance.” We also received a stack of pre-printed prescriptions for opioids….just sign and put in your DEA number! One Christmas Eve, I met a young couple at my office for an emergency office consult. The upper canine had an apical radiolucency, she knew she needed root canal therapy and her dentist back home was covering the situation. Could I please open the tooth to take the pressure off the nerve? I wrote scripts for antibiotics and opioids and the couple promised to come to the office on December 27 at 8am for the start of endodontics. Yes…at 10 am on the 27th I realized that I had been taken for a ride! Any one of us in clinical practice can share similar stories. In retrospect it is obvious that, at some level, we in dentistry were drawn into over prescribing opioids. Maybe it was out of compassion for our patients. Maybe it was due to pressure from the drug manufacturers and sales people. Maybe it was a result of a cavalier attitude in society toward pain control and a denial of the dangers of addiction. WHATEVER THE REASON…THE TIMES AND STANDARDS HAVE CHANGED! In response to the OPIOID ADDICTION CRISIS and a directive by the Governor of New Mexico to address the crisis, your New Mexico Board of Dental Health Care made proactive changes to the rules and statutes that govern the practice of dentistry in New Mexico. Please read, review and remember the rules. Here are some guidelines.  • For any opioid prescription greater than a four day duration, the prescribing dentist must check the PMP.  • There is NO CALL IN PRIVILEGE for opioids.  • Every dentist who prescribes opioids must take a course in pain management every three years.  • Rogue prescriptions will be identified by the PMP and reported to the NMBDHC for disciplinary review. AND NOW THE GOOD NEWS! DENTISTRY has led the positive response to the Governor’s imitative to decrease the amount of prescription opioids given to patients. This has been publicly acknowledged. The New Mexico Dental Association offers pain management courses regularly for the dentists of New Mexico at the Annual Session. Component District Dental Societies offer pain management courses at their district meetings. Your New Mexico Board of Dental Health Care would like to thank the responsible and diligent dentists who have made positive changes in their prescribing and pain management protocols as they serve the patients of New Mexico. KEEP UP THE GOOD WORK!!!! In Peace and Respect, L. Paul Balderamos DDS, MS, FACP Vice-Chairman New Mexico Board of Dental Health Care