Study: Rural dentists show higher awareness of opioid epidemic in their prescribing, and are in good positions to fight it

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While rural and non-rural dentists prescribe about the same number of pain pills, rural dentists do so more often in combination with ibuprofen or acetaminophen and at lower dosage rates. So says a new study, which also found that rural dentists are more likely to have suspected their patients of drug abuse — and not prescribed opioids to them as a result of that suspicion.

The study, published in The Journal of Rural Health, pointed out that rural dentists are in a great position to help combat the opioid crisis, largely because rural communities have been hit so hard by the opioid epidemic and because dentists prescribe about 12 percent of annual opioid prescriptions.

“Recognizing and engaging rural dentists as leaders in addressing opioid misuse will be an important step toward reducing the fatal impacts of this epidemic among rural communities,” the researchers write. “Rural dentists encountering this epidemic can implement screening for opioid misuse and abuse, as well as provide a referral for treatment.”

The researchers delivered an online survey to dentists in the National Dental Practice-Based Research Network to measure both rural and non-rural dentists’ pain management practices, their perceptions of the scope of the problem and the perceived adequacy of their training around preventing the misuse and abuse of opioids.

The survey excluded those who did not provide an e-mail address, and those who practiced exclusively in orthodontics, oral pathology or pediatric dentistry, because those types of practices rarely prescribe opioids. Of the 822 dentists who completed the survey, 91 were in a rural practice and 731 were not; 11.1% of them were in an area that is short of health professionals. Rural practice was defined as those with a ZIP code with more than 50% of its population living in a non-metropolitan county or in a rural census tract. (Many metro counties have rural census tracts.)

“Rural dentists were significantly more likely to prescribe opioids in combination with a recommendation to use ibuprofen or acetaminophen for pain management, and were significantly less likely to prescribe six to seven days’ supply of opioids,” the researchers report. They also found that only one-third of the dentists said their training to prevent misuse or abuse of opioids was “sufficient and up to date.” Rural dentists appeared slightly less likely to say that. The rest said their training was either sufficient, but out of date; insufficient; or that they had received no such training.

The researchers said the American Dental Association‘s new policy was a great support for dentists because it sets limitations for opioid dosage and duration for acute pain, elevates the significance of mandatory continuing education for prescribing opioids and other controlled substances, and provides a recommendation for dentists to use state prescription-drug monitoring programs.

The journal article concludes, “Dentists should employ recommended risk-mitigation strategies broadly, as a substantial segment of dental patients report at least some non-medical use of their pain medications, and recent substance abuse—including problematic alcohol use or illicit drug use—has been reported by approximately one in five dental patients.”

The article acknowledged several limitations to the study: Self-reported data is retrospective in nature, making it subject to potential bias; no objective prescribing data was collected; a patients may live in a different ZIP code (perhaps an urban one) than the dentist; and the study did not differentiate between the complexity of procedures as potential reasons for the dentists’ prescribing practices.

The corresponding author of the study report is Dr. Jenna McCauley of the Department of Psychiatry and Behavioral Sciences at the Medical University of South Carolina. The editor of the Journal of Rural Health is Ty Borders, director of the Rural and Underserved Health Research Center at the University of Kentucky.

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