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Reducing Opioid Prescriptions Related to Oral Care · Talking FACS

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  Welcome to Talking FACS, what you need to know about family,
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  food, finance, and fitness.
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  This nationally recognized, award-winning podcast is hosted by the University
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  of Kentucky Family and Consumer Sciences Extension Program.
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  Our educators share research knowledge with individuals, families,
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  and communities to improve quality of life.
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  Hello, and welcome to Kentucky Smiles on Talking FACS, a podcast collaboration
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  between the University of Kentucky College of Dentistry and Family and Consumer Sciences Extension.
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  I'm your host, Mindy McCulley, Extension Specialist for Instructional Support
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  with Family and Consumer Sciences Extension.
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  Nearly 60% of opioids prescribed for 42% of opioid prescriptions given to adolescents
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  and young adults are prescribed by dentists.
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  My guest today, Dr. Marcia Rojas Ramirez with the UK College of Dentistry,
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  is here to share with us about ADOPT, Alternatives to Dental Opioid Prescribing
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  After Tooth Extraction.
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  Welcome, Dr. Rojas Ramirez.
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  Hello, Mindy. Thank you so much for giving me the opportunity to join your podcast today.
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  Well, we are excited to learn about ADOPT and the goals of ADOPT's study. So what are they?
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  So ADOPT is a very interesting study that involves the collaboration of multiple
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  colleges in the University of Kentucky, where the College of Dentistry,
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  the College of Pharmacy, Medicine, and Public Health get together to find possibilities and
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  opportunities to reduce the number of opiate prescriptions that go out to the
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  community to specifically to adolescents and young adults,
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  meaning this population between the ages of 12 and 25,
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  that get a tooth extracted.
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  So it would be the goals of this study is to minimize the number of prescriptions
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  that are given, dental prescriptions that are given to this specific population.
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  Why is the concern of prescribing opioids to this population so troubling?
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  So adolescents and young adults are a population that is specifically high risk
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  of opioid misuse or abuse. use.
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  This is a specific period where the brain is still in development,
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  where it's really receptive to the reward centers,
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  to euphoria, sensations, and this is a specific effect of opioid substances.
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  So, opioid use disorder can develop at any time, regardless of race, age,
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  gender, and these This group is in a study that we conducted a few years ago
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  where we looked at the dental lobby prescriptions that were given by dentists
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  and we look at the specifics of the population that were receiving these medications.
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  We identified that compared to other age groups, adolescents and young adults
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  were the group that were receiving the highest doses of these medications for the longest duration.
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  Okay. So not only they are at high risk, are at very high risk for misuse,
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  but they're also the ones receiving the majority of these medications.
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  So are there other medications that can be prescribed that will have the same
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  benefit but aren't at high risk of becoming misused?
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  Yes, yes. Yes. So the first line of treatment after surgical procedure or for
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  the management of acute pain would be the use of non-opioid analgesics.
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  Okay. And non-opioid analgesics would involve NSAID medications like your ibuprofen
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  or in combination alone or in combination with medications such as Tylenol or acetaminophen.
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  So when given together, what we have learned is that they create an increase
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  in the analgesic effect.
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  There was this very interesting study that was published back in 2020 where
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  they follow individuals that received a tooth extraction and a group of them
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  received opioids and a group of them received non-opioids analgesics.
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  And what we have learned from this study and from many other research is that,
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  Those individuals who received opioids had the worst pain outcomes.
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  So it was not necessarily the group
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  that received or that obtained more analgesia or better pain control.
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  So opioid medications are not linked to better pain management,
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  produce higher side effects, and on top of everything, have a much higher incidence
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  or a potential for misuse and abuse of these substances. Okay.
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  So, why is this work so important for Kentuckians?
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  So it is really important because Kentucky has been a population,
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  has been a state that has been really affected by the opioid epidemic.
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  And as you mentioned at the beginning, so many of the opioids that we prescribe are left unused.
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  And it happens that unused medication is one of the first ways that individuals start misusing drugs.
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  So this creates this diversion, and this diversion can come from a family member, from a provider.
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  So there are different methods of getting access to these medications.
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  So reducing the amount of medications that can be left unused at the community
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  level, it's a method of reducing the potential of having more individuals get
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  access to these substances.
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  That makes really good sense. If we don't prescribe them to begin with,
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  then they're not going to be left over.
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  Exactly. Exactly. So what is your specific role in regards to this study?
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  So this study has what we call two principal investigators.
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  The main principal investigator is in the College of Pharmacy,
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  and I am the other principal investigator at the College of Dentistry.
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  So between the two of us, we are in charge of running this study,
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  making sure that all the procedures are developed, that we enroll the clinics,
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  that we keep up and monitoring the trial as it advances.
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  This is a four-year clinical trial where we are engaging not only academic institutions,
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  but also community dental practices.
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  The rationale behind this is that when we looked at the number of opiate prescriptions
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  that we had in the state of Kentucky over like a seven-year period,
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  we realized that the academic prescriptions or prescriptions that come from
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  dentists that work in academic settings,
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  just a very small number of those prescriptions.
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  So in order to be able to make an impact and really reduce the amount of opioids
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  that prescription, the opioid medications that can be out in the community as leftover medication,
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  we really need to engage the community settings, which are where the majority
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  of these medications are being prescribed.
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  So, this trial is engaging academic settings and then community settings,
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  and we're following these clinics over a period of four years.
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  And our goal is that after the intervention, right, and I can discuss with you
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  in a little more detail what that will look like.
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  But the goal would be that after this intervention is given to these different
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  practices, we would be able to notice a reduction in these prescriptions.
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  And our role is to make sure that the trial is conducted the way we said that
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  was going to be conducted and that we are monitoring the trial,
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  monitoring any adverse events,
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  monitoring monitoring the outcomes so we can provide good evidence-based conclusions
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  at the end of these trials.
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  So you said that this is a four-year study. What year are you in now?
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  We are starting here our first year. We have four more years to go.
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  Okay. We just activated the study back in April.
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  Okay. So it's brand new. And what does the intervention look like?
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  This study has three different types of interventions that will be applied at
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  different levels. So the main intervention is what we call an academic detailing intervention.
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  And this intervention is targeted to the dental providers.
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  And it would be a one-one interaction between the dental provider and trained
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  pharmacist, where they will go over the guidelines for acute pain management.
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  What are is basically a conversation so that we can understand their prescribing
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  circumstances, when and how they make a decision to prescribe.
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  Are there any data driven information that we can provide?
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  So then some of those scenarios where making the decision is difficult,
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  that can expedite or that can give them an evidence based statement so they
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  can reduce or avoid that particular prescription.
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  And basically provide a guidance. Right.
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  For the providers during these settings.
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  The next part of this intervention is targeting to the facilitating the non-opioids
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  are the first line of treatment.
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  And in order to do that, we're providing these clinics what we call blister
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  packs of non-opioid analgesics.
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  So, So this would be pre-packed medication that has the dose of the non-opioid
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  so they can take it at specific times throughout the day for a course of a maximum seven days.
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  So when they leave the practice, they don't need to go to the pharmacy and get
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  this non-opioid analgesia. They just have it there. It's handy.
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  It's easy to use. And then it helps them to keep track of, well,
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  did I take it three hours ago or not? They can visually keep track of their medication intake.
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  And the last piece of this intervention is a
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  tailored patient post-extraction instructions where the patients will be able
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  to take this flyer that has information about non-pharmacological or a set of
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  instructions that don't involve the intake of medications, right?
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  Of things that they can do to control the pain that are not medication related.
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  And then it also has information, well, if you are going to take your medications,
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  take them as prescribed.
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  And it provides additional information about the risks of certain medications,
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  as well as information of how to dispose some of these unused medications.
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  So, you know, it's not that we are saying that.
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  There is no need for opiate prescription. There will be certain cases where
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  an opiate prescription may assist in controlling the pain,
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  but this intervention provides the resources so the provider can train and instruct
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  the patient on what would be some of the, how to dispose the medication,
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  what are some of the risks that they can assess before they give a prescription medication.
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  So then if that occurs, we reduce the risks of having misuse with that link
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  to that specific prescription.
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  I'm guessing that these interventions will help to alleviate some of the barriers
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  that providers might encounter to not going this route.
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  You know, it might be easier to write a script for an opioid if they didn't
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  have all of these interventions in place already.
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  Yes, yes. So the goal is that we will learn a little bit of what is that thought
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  process and what are some of the most common barriers.
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  So then these could be later on presented to the more general dental population
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  tackling those specific circumstances that they bring up as well. And.
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  It helps the provider to have a conversation with an individual that is trained
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  on how to overcome some of those barriers.
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  So then the brainstorming about how to solve a specific circumstance or how
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  to deal with a patient that is really pushing towards a prescription to get
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  a prescription of opioids,
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  It's how to navigate some of those difficult situations that happen on a regular
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  basis in a dental setting.
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  So one of the important things after or when you're going for a tooth extraction
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  is to be able to adjust expectations, right?
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  So this would be an invasive procedure, whether it's going to be one tooth or
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  two or three or four or more teeth that are coming out. Now,
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  you know, there is some discomfort to be extant after this procedure.
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  So being able to adjust what your pain expectations would be also sets an environment
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  of saying, well, you know, I'm having some discomfort, but it's not enough to
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  need to take way more medication.
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  And it promotes also some self-care and utilization of non-pharmacological options
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  like ice in the place, you know, in the face where the procedure was done, soft diet.
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  Things of that sort that will help and promote the healing.
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  And then the utilization only of the Tylenol and ibuprofen that together enhance
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  that pain control after a procedure like that.
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  And also to know that every day, you know, the goal would be that every day
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  you feel a little better.
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  So then after those Those three days when the inflammation and the pain peak,
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  you should start noticing a significant reduction in your pain with the very
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  basic first line pain management options.
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  And if that is not the case and you are noticing that your pain either stays
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  the same or is increasing, well, then that is a time where it's important to
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  call your dentist again and say, well, this pain is not getting any better.
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  Can you please get me in to see if there is an infection or if there's any other
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  factor that may be contributing to the pain and not necessarily the extraction itself?
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  That is excellent advice. So don't plan to have your teeth extracted and then
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  go on a big trip the next day.
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  Yes. Enough some time to heal, right?
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  Allow your body to heal and promote an environment where it can do that.
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  Excellent. And my husband is opposed to any type of pain medication because
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  he knows what it does to his body and how it affects him.
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  And so knowing that, mixing that ibuprofen and the Tylenol together has a similar
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  effect would be beneficial to him to know that,
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  then maybe he would be be willing to go that route and know that he would get that same effect.
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  So that would be beneficial information for someone like my husband. Yeah.
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  So that is part of the information that is provided to the patient.
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  So then it is part of that educational portion of this intervention of saying,
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  well, you know, not only non-opioids tend to be more effective to manage your
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  pain, but they also have,
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  you know, they'll make you feel less sick in terms of the side effects.
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  And in terms of how satisfied patients are after a procedure,
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  tends to be that there's really not a lot of difference.
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  Sometimes providers think, well, if I don't give this prescription,
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  the patients may not like it or they may not feel that I'm not taking care of their pain.
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  But that really, patients are equally satisfied. there are no difference in
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  terms of how they perceive the procedure went.
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  Right. And the fact that they have less side effects tend to be more of a pro
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  for the non-opioid analgesics.
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  I hope that this study turns out the way that it sounds like it really could.
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  And it will be a win-win for Kentucky, and it will be a win-win for those who
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  have to have tooth extractions or other surgeries. Well, thank you so much.
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  We are looking for the same outcomes. We're working hard and very excited to
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  be able to deliver our intervention to engage.
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  We have the clinics that are participating, our sites that are very engaged,
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  our sites that believe in the work that this intervention is aiming to do.
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  We hope to be able to minimize the risk for our Kentucky youth and reduce the
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  chances of more and more of our adolescents
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  and young adults having the opportunity or having the, you know,
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  the chance of misusing some of these substances.
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  That all sounds fabulous. Thank you so much for your time and for visiting with me today.
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  Thank you for having me join you. if you are just tuning in you are listening
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  Music.