CDA Essentials 2019 • Volume 6 • Issue 5

26 | 2019 | Issue 5 N ews and E vents The opioid formulation most commonly prescribed by dentists, by a large margin, was codeine combination products (97.4%), followed by tramadol and acetaminophen (1.7%) and oxycodone combination products (0.7%). Prescribing practices for combination products containing 15 and 30 mg of codeine, as well as for oxycodone combination products, were mostly appropriate according to available practice guidelines, in terms of:  Quantity of tablets dispensed - For 15 mg codeine combinations, the Royal College of Dental Surgeons of Ontario (RCDSO) dental opioid use guideline 2 suggests limiting the number of tablets to a maximum of 36; this was true for 98.7% of 15 mg codeine combination prescriptions by dentists. - For 30 mg codeine combinations, the RCDSO guideline suggests limiting the number of tablets to no more than 24 tablets; this was true for 51.5% of 30 mg codeine combination and for 52.7% of oxycodone combination prescriptions by dentists.  Prescription days’ supply - The RCDSO guideline 2 suggests prescribing a 3-day supply of analgesics for managing post-operative pain; this was met by 59.7% of 15 mg codeine combinations, 51.6% of 30 mg codeine combinations, and 49.5% of oxycodone combination prescriptions.  MMEs per day - The Guideline for Opioid Therapy and Chronic Noncancer Pain 3 suggests restricting the maximum prescribed dose to less than 50 MMEs per day; only 5.6% of first opioid prescriptions by dentists exceeded this suggested maximum dose, and only 0.06% of first opioid prescriptions were written for 90 or more MMEs per day (the recommended maximum dose). Dr. Jamie Falk, one of the study authors, credits Manitoba’s regulatory framework, including a prescription monitoring program and a requirement for prescribers to apply for a specific opioid prescription pad before they can prescribe high-potency opioids, for the lower levels of high-dose prescribing by Manitoba dentists compared to other jurisdictions. “Our study found that only about 5% of dental opioid prescriptions were for greater than 50 MMEs per day; in contrast, a publication from Ontario showed about 14% had greater than 50 MMEs in dental prescriptions,” he says. “So in comparison we see that our numbers are quite a bit lower when it comes to higher potency opioids being used.” Prescribing can be further improved by prescribing smaller prescription quantities of opioids or even avoiding use of opioids for treating dental pain, says Dr. Falk. “It’s a fairly commonly held view that for most dental procedures, we don’t need to use opioids. In many cases, the first option is an NSAID or acetaminophen. Continuing to strive to avoid opioids in dental prescribing is an important goal to work towards.” a Reference 1. Falk J, Friesen KJ, Magnusson C, Schroth RJ, Bugden S. Opioid prescribing by dentists in Manitoba, Canada: A longitudinal analysis. J Am Dent Assoc. 2019;150(2):122-29. 2. RoyalCollegeofDentalSurgeonsofOntario. TheRoleofOpioids intheManagementofAcuteandChronicPain inDentalPractice. Toronto,ON,Canada:RCDSO;2015. Available at: https://az184419.vo.msecnd.net/rcdso/pdf/guidelines/RCDSO_Guidelines_Role_of_Opioids.pdf 3. Busse JW, Craigie S, Juurlink DN, Buckley DN, Wang L, et al. Guideline for opioid therapy and chronic noncancer pain. CMAJ. 2017 May 8;189(18):E659-E666. Available at: http://www.cmaj.ca/content/189/18/E659 Dr. Jamie Falk In many cases, the first option is an NSAID or acetaminophen. Continuing to strive to avoid opioids in dental prescribing is an important goal to work towards. Visit CDA Oasis to hear Dr. Falk discuss the study: wp.me/p2Lv6A-6Iy