COMING UP SOON. Opioid Abuse in the U.S. and the Implications for Dental Education. An ADEA Special Webinar

Transcription

1 COMING UP SOON Opioid Abuse in the U.S. and the Implications for Dental Education An ADEA Special Webinar

2 Opioid Abuse in the U.S. and the Implications for Dental Education An ADEA Special Webinar

3 P: Join the Conversation on Twitter and tweet live during today s event! Use this hashtag throughout today s webinar. #opioidcrisis

4 P: ADEA Webinar Host Evelyn Lucas-Perry, D.D.S., M.P.H. ADEA Director for Public Policy Research

5 P: Today s Presenters Ronald J. Kulich, Ph.D. Professor Tufts University School of Dental Medicine David A. Keith, B.D.S., FDSRCS, D.M.D. Professor of Oral & Maxillofacial Surgery Harvard School of Dental Medicine Richard D Innocenzo, D.M.D., M.D. Clinical Professor & Director of Predoctoral Oral Surgery Education Boston University Henry M. Goldman School of Dental Medicine

6 Objectives This webinar will enable participants to: Specify key events and statistics regarding opioid abuse in health care with a focus on dentistry. Discuss the Massachusetts model of bringing attention to, and leading change for, responding to opioid abuse at a state and national level. Identify implications for academic dental education and curriculum.

7 Opioid Abuse in the U.S. and the Implications for Dental Education: an ADEA Special Webinar Opioid Abuse in the U.S. Statistics and Trends Ronald J. Kulich, Ph.D. Professor Craniofacial Pain and Headache Center Dept. of Diagnostic Sciences Tufts University School of Dental Medicine Lecturer, Department of Anesthesia, Critical Care and Pain Medicine Massachusetts General Hospital Harvard Medical School

8 Risk Screening in the Curriculum

9 Overdose deaths are continuing despite a reduction in prescribing!

10 Risk Factors Of the 22,767 deaths relating to prescription drug overdose in 2013, 16,235 (71.3%) involved opioid painkillers, and 6,973 (30.6%) involved benzodiazepines. People who died of drug overdoses often had a combination of benzodiazepines and opioid painkillers in their bodies.

11 Source Where User Obtained Updated se/data/prescribing.html Source Where Pain Relievers Were Obtained for Most Recent Nonmedical Use Among Past Year Users Aged 12 or Older:

12 Boston Globe Street Rx

13 Dentistry & Opioids < % of scripts had been hydrocodone and oxycodone 19.1% for <2 wks; 65.4% < 2-3wks Dentists were writing 8% of the opioids, right behind PCPs and internists (in the past) Dentists wrote billion doses of IR opioids each year Passik, 2014 Review, Advances in Therapy

14 ER decrease in opioid writing (9%) 2015 Dentistry decrease in opioid writing (6%) 3/4 of U.S. dentists report that they ask their patients about substance misuse 2/3 do not agree that such screening is compatible with their professional role

15 Special Populations in Dentistry: The Woman of Childbearing Age Tolia VN et al. N Engl J Med 2015;372:

16 Moving to 2016 Dentists who accepted substance misuse screening as part of their professional role Prior experience and knowledge about substance misuse = the strongest predictors of dentists inquiry about substance use/misuse and acceptance of screening as part of their role (P<0.05). Parish et al., 2015

17 Summary Guidelines for Dentistry & Acute Pain Dinesco RC, Kenna GA, O Neil MG, Kulich RJ, Moore PA, Kane WT, Mehta NR, Hersh EV, Katz N. Prevention of prescription opioid abuse: The role of the dentist. The Journal of the American Dental Association July 1, 2011 vol. 142 no 7, You will need to: fully assess the patient w rite short scripts consider alternatives to opioids Provide adequate pain relief!

18 ADEA Special Webinar Opioid Abuse in the U.S. and the Implications for Dental Education Ronald J. Kulich, Ph.D. Tufts University School of Dental Medicine The Host David A. Keith, B.D.S., FDSRCS, D.M.D. Harvard School of Dental Medicine Richard D Innocenzo, D.M.D., M.D. Boston University Henry M. Goldman School of Dental Medicine Evelyn Lucas-Perry, D.D.S., M.P.H. American Dental Education Association

19 Opioid Abuse in the U.S. and the Implications for Dental Education: an ADEA Special Webinar The Massachusetts Model: Taking Collaborative Action David A. Keith, B.D.S., FDSRCS, D.M.D. Professor of Oral & Maxillofacial surgery Harvard School of Dental Medicine

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21 The Tip of the Iceberg 1 opioid overdose death 15 abuse treatment admissions 26 Emergency Room visits 115 who abuse/are dependent 733 non-medical users

22 Massachusetts Massachusetts Governor Charlie Baker and AG Healey have made opioid abuse issues a priority and have proposed several initiatives -Mass.gov/stopaddiction

23 Governor Charlie Baker The other thing that makes the opioid issue a little different, if not significantly different, is that many people who wind up addicted to opioids or heroin started with a prescription that was written for them by a doctor or a dentist Boston Magazine Catching up with Charlie Baker by Garrett Quinn pp. 43-7, February 2016

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25 The Practice of Dentistry Differs From the Practice of Medicine Nationwide 78.4 % of dentists work in solo practices ADA Practice Survey 2010 Dentists deal predominantly with acute pain and have limited experience with chronic pain More integration is required between dentistry and medicine Although implementation has begun, at this time there is no accredited specialty of orofacial pain, resulting in few resources

26 This initiative has been made possible because of: State Government Leadership Collaboration between the three Boston dental schools, deans and faculty Support from the Massachusetts Dental Society Encouragement from Student Coalition on Addiction

27 Opioid Abuse in the U.S. and the Implications for Dental Education: an ADEA Special Webinar Implications for Dental Education and Curriculum Richard D Innocenzo, D.M.D., M.D. Clinical Professor & Director of Predoctoral Oral Surgery Education Boston University Henry M. Goldman School of Dental Medicine

28 Dental Education Core Competencies for the Prevention and Management of Prescription Drug Misuse Recommendations From the Governor's Dental Education Working Group on Prescription Drug Misuse January 2016

29 Core Competencies Developed from the perspective of an encounter with a patient in which a prescription with a potential for misuse may be indicated Goal is to support future prescribers with the skills and knowledge to prevent prescription medication misuse Provide a bridge between student education and residency training Serve to competently prescribe medication and to prevent, identify, and treat substance use disorders Addressing the Opioid Epidemic in Massachusetts, Mass DPH 2/11/16

30 Primary Prevention Domain Preventing Prescription Drug Misuse Screening, Evaluation, and Prevention of Substance Misuse During the Diagnosis of Dental and Orofacial Pain Evaluate a patient s pain and develop an appropriate differential diagnosis Evaluate a patient s risk for substance use disorders Identify and describe potential pharmacological and non-pharmacological treatment options including opioid and non-opioid treatments for acute and chronic pain management along with risk and benefits, the securing of medications, and proper disposal Recommendations From the Governor's Dental Education Working Group on Prescription Drug Misuse January 2016

31 Secondary Prevention Domain Treating Patients At-Risk for Substance Use Disorders Engage Patients in Safe, Informed, and Patient- Centered Treatment Planning Demonstrate the ability to appropriately refer patients for consultation and collaboration with their care providers Practice evidence-based and patient-centered pain management treatment plans Safe prescribing and recognizing patients displaying signs of aberrant prescription use behaviors Demonstrate the foundational skills in patientcentered counseling and behavior change in a the context of a patient encounter Recommendations From the Governor's Dental Education Working Group on Prescription Drug Misuse January 2016

32 Tertiary Prevention Domain Managing Substance Use as a Chronic Disease Eliminate Stigma and Advance Interdisciplinary and Interprofessional Collaborative Efforts to Reduce Substance Misuse Recognize the role of currently available screening instruments for at-risk patients Work toward eliminating the stigma associated with substance misuse Develop models of interprofessional education and engage in collaborative training Recommendations From the Governor's Dental Education Working Group on Prescription Drug Misuse January 2016

33 Allows schools to tailor the competencies to their own curriculum development

34 Similarities in Curriculum Clinical component PMP Use of CE courses Intra- and interprofessional education

35 Harvard School of Dental Medicine Lead institution in the Boston-based CoEPE (NIH Pain Consortium Centers of Excellence in Pain Education, 2015) Collaboration to teach appropriate controlled substance prescribing via intra- and interprofessional education HSDM and HMS introducing a new combined curriculum Longitudinal Practice of Medicine: Hospital and outpatient sites First year HSDM teaching practice provides experience in the dental clinic setting to evaluate patients (screening, understand pain management, and PMP) Essentials of the Profession: Brings together the social and population science relevant to the practice of medicine Advanced Graduate Education Programs: Shared core curriculum, with pharmacology as one of the core courses Recommendations From the Governor's Dental Education Working Group on Prescription Drug Misuse January 2016, Information obtained in preparation for submission to JDE

36 Tufts University School of Dental Medicine Established an interprofessional working group Further incorporate contents of the recommended curriculum into the undergraduate and graduate dental programs Proposing strategies to integrate the curriculum content directly into the students within-clinic training experience Massachusetts PMP Increase student attendance at postgraduate CE interprofessional training directed at substance use screening and pain management Student and faculty research in risk screening pain management Recommendations From the Governor's Dental Education Working Group on Prescription Drug Misuse January 2016, Information obtained in preparation for submission to JDE

37 Boston University Henry M. Goldman School of Dental Medicine SBIRT model (Screening, Brief Intervention, and Referral to Treatment) In Collaboration with the Boston University School of Medicine through the BESST student training program (Boston University Evidence-Based Student SBIRT Training), which is funded by a recently awarded SAMHSA grant Goal: Enhance existing substance use/misuse curriculum in the areas of behavioral health, patient communication, and interprofessional team-based practice in an integrated and multidisciplinary collaborative environment Update and incorporate contents of the recommended curriculum Didactic courses Clinical experience Online CE program Recommendations From the Governor's Dental Education Working Group on Prescription Drug Misuse January 2016, Information obtained in preparation for submission to JDE

38 Assessment of Competencies Evaluate students for baseline and postimplementation measurements Performance-based evaluation Utilizing clinical settings or simulation And/or objective patient-based assessments using standardized patients and technologyenhanced simulation

39 Opioid Abuse in the U.S. and the Implications for Dental Education An ADEA Special Webinar DISCUSSION

40 ADEA Special Webinar Opioid Abuse in the U.S. and the Implications for Dental Education Ronald J. Kulich, Ph.D. Tufts University School of Dental Medicine David A. Keith, B.D.S., FDSRCS, D.M.D. Harvard School of Dental Medicine Richard D Innocenzo, D.M.D., M.D. Boston University Henry M. Goldman School of Dental Medicine rdinno@bu.edu

41 Opioid Abuse in the U.S. and the Implications for Dental Education An ADEA Special Webinar THANK YOU!