Over the past several years, the U.S. has taken major steps to address the addiction, overdose and significantly increasing number of unintended deaths resulting from prescription opioid drugs, such as Vicodin or Percocet.
One such step was setting up a Prescription Drug Monitoring Program (PDMP), where providers can check a database to see if a particular patient had been prescribed these controlled substances by other providers in recent days or weeks. Met with resistance on the part of providers (no resources to spare, more steps in an already busy day), there wasn’t much change. But when many states made the monitoring mandatory, change began to occur in the medical community.
Since urgent dental clinics are a common place for prescribing pain medication, UR Medicine’s Eastman Institute for Oral Health wanted to take a scientific approach to see if the mandatory program has been effective in the dental community, as well.
“Opioid drugs are addictive, and those who are addicted tend to shop around,” explained Dr. Yan-Fang Ren, clinical chief of Eastman’s urgent dental clinic. “We often see patients who tell us they have a terrible toothache, and need pain medication. Tooth pain is very subjective, and can be tricky to assess the validity of a patient’s pain, especially when they clearly have oral health issues.”
Similar to the people who don’t have medical insurance or a primary care physician who go to a hospital emergency room for minor health issues, so do people without dental insurance or a dentist and will show up at Eastman’s urgent dental care walk-in clinic.
“We see patients all the time who haven’t been to a dentist in years,” said Dr. Ren. “As a result, they can have a wide range of untreated oral health issues, which can cause minimal or extreme pain. If they decline treatment, we do what we can to address the issue at hand and get them out of pain.”
Dr. Ren conducted a nine-month study to see the impact of New York’s mandate to check the prescription drug history of any patient before prescribing a controlled substance. He reviewed patient records for three months before the mandate began, and then two consecutive three-month periods after the mandate was implanted.
“After comparing and analyzing the number of visits, treatment types and drug prescriptions,” Dr. Ren explained, “the number of opioid prescriptions decreased by 78 percent, while the number of non-opioid analgesics, such as ibuprofen, increased.”
The study, which was published recently in PLOS One, clearly shows that the mandatory PDMP significantly affected the prescription pattern for pain medications by dentists in an urgent care dental clinic and represents one of the first evidence-based studies on the subject. However, Dr. Ren emphasizes that more studies need to be done to understand the impact of PDMP on other practices.
“I’m very glad New York and other states have mandated the monitoring program,” Dr. Ren added. “With prescription drug overdose deaths ahead of heroin and cocaine, this should have a major impact.”