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Dental patients in Ontario are getting the right drug, in the right amount, and only once. Such welcome good news were communicated in the recent report published by the College of Dental Surgeons of Ontario (RCDSO), using data from 2014 to 2016 of opioid prescriptions given by dentists and dispensed by dental patients: Opioid Prescribing by Ontario Dentists 2014-2016. In the midst of the opioid crisis plaguing North America, this is such a welcome message for dentists. It is certainly the result of a concerted effort within organized dentistry to help dentists reduce the exposure of their patients to the harms of opioids. I had the pleasure to speak with Irwin Fefergrad, RCDSO Registrar and Michael Gardner, Director of Quality Assurance at the College. They told me about the bigger picture of their initiatives and their educational and communication strategies which successfully helped shape the downward trend of opioid prescriptions among Ontario dentists. I hope you find the conversation informative; and as always, we would love to hear from you about your thoughts, suggestions, and questions. We are always at oasisdiscussions@cda-adc.ca Until next time! Chiraz Guessaier, CDA Oasis Manager |
Highlights
In 2012 the Royal College of Dental Surgeons of Ontario (RCDSO) began work on Guidelines for the Management of Acute and Chronic Pain in Dental Practice to address:
- Best practices for the safe and effective use of analgesics, including tools to assist dentists in making appropriate prescribing decisions
- Collaboration with physicians, pharmacists and other health care providers in the management of chronic pain
- Management of the specific risks for opioid use, misuse and abuse.
The Guidelines were published in November 2015 and a voluntary survey of dental practitioners in Ontario was completed. The Health Analytics Branch of the Ontario Ministry of Health and Long Term Care was asked for data from the Narcotics Monitoring System regarding the opioid prescribing patterns of dentists in Ontario. The College received prescription dispense data for the calendar years 2014, 2015 and 2016. These were analyzed to assess the level of opioid prescribing by dentists, changes to prescribing patterns over the years and the impact of the Guidelines released in late 2014.
The results are encouraging. Dispense events per dentist are about 1.2 dispenses per patient and most patients only get 1 prescription. This strongly suggests that dental patients in Ontario are getting the right drug, in the right amount and only once.
Even over a relatively short time span, the data show a statistically significant decrease in opioid prescriptions and the amount of drugs made available via dentists in Ontario since 2014 – about 4.4% over two years. There are some results that provide a framework for further examination by groups and individuals – the number and type of prescriptions by district shows some variation – but none that suggest problematic prescription patterns. Other results were expected; specialists, for example, prescribe more pain medications because of the type of patients they are treating.
Key findings
- Dentists dispense events were 3.3% of the total in 2014 compared to physician’s dispense events of 96.7%.
- Dentists prescribed opioids for 12% of all opioid patients with 9% by dentists only (in 2014).
- Dentist dispenses per patient was 1.3 in 2014; physicians’ rate was 5.0.
- Tylenol 2/3, Percocet, Tramadol, Meperidine and Oxycodone account for 97.5% of the dentist opioid dispense events.
- Tylenol 2/3 was the most (75%) prescribed opioid by dentists.
- Dispenses per patient were higher for general dentists.
- There were differences in dispense event patterns by dental specialty and by opioid.
- Patients generally received prescriptions from one dentist.
Additional Resource
Full Interview (19.28″)