Confronting the Opioid Epidemic: How Dental Schools Can Lead

The opioid crisis is not one epidemic; it is several intertwined epidemics, or a syndemic (theconversation.com/opioid-epidemic-causing-rise-in-hepatitis-c-infections-and-other-serious-illnesses-82040). The crisis knows no race or class. If you are not personally touched by addiction, it’s likely that you know someone who has been affected. More individuals die from opioid overdoses than car accidents. It took more than a decade to reach this crisis point, and it will take as long or longer to get out of it. We are bearing witness each day, but we also need to take action. Dental schools have a critical role in that work.

Dentists are generally in the top tier of practitioners prescribing painkillers. For some age groups, especially during the vulnerable teen years, dentists prescribe more opioids than even general practitioners or physicians in emergency rooms.¹

The Centers for Disease Control and Prevention (CDC) reports that there has been a 200% increase since 2000 in the rate of deaths from overdoses involving opioids.² Approximately 4% of individuals age 11 and older in Massachusetts have an opioid use disorder. From 2000 to 2016, the state saw a 450% increase in opioid-related deaths. Just like diabetes, addiction is a chronic disease with co-occurring disorders. In addition to rising rates of overdoses and deaths, we’ve seen a jump in HIV, hepatitis C, and other infections as a result of injection drug use.

To combat those startling statistics, the Baker-Polito Administration of Massachusetts, in partnership with the deans of the state’s three dental schools and the Massachusetts Dental Society, announced a first-in-the-nation set of dental education core competencies for the prevention and management of prescription drug misuse. Our goal was to have the schools work together to change their curricula to ensure that every student graduates with enough knowledge about pain management and opioid therapy to fight abuse (blog.mass.gov/governor/opioid-addiction/governor-baker-announces-dental-education-standards-to-combat-opioid-epidemic/ and www.mass.gov/orgs/department-of-public-health).

We’ve extended that work to medical, nursing, and social work schools in the state and soon to our pharmacy schools—covering more than 12,000 students. Educating future generations of dentists and other health care providers is just one part of a comprehensive strategy.

We’ve taken legislative actions to limit opioid prescriptions, both the supply and length of the prescription (blog.mass.gov/masslawlib/new-laws/new-opioid-law/), and created a prescription monitoring program (www.mass.gov/eohhs/gov/departments/dph/programs/hcq/drug-control/pmp/) that requires providers to check into a database before writing new prescriptions for Schedule II–V substances. Massachusetts law limits first-time opioid prescriptions to seven days including in dental practices.

We’re also equipping providers with a set of tools to prevent and treat addiction and developing strategies for managing overdoses (www.mass.gov/eohhs/docs/dph/substance-abuse/opioid/overdoseresponsestrategies.pdf). We’re partnering with the community to link individuals with substance use disorders with the resources they need to address the social factors that may prevent them from getting treatment like adequate housing and stigma. We have also provided information to families, community members, municipalities, state agencies, first responders, and treatment providers on overdose prevention and naloxone access.

We’re encouraged to see that our efforts to tackle the opioid crisis aren’t going unnoticed. We must continue to fight this terrible disease head on, with strong partners including the dental community who stand with the Administration of Massachusetts on the battle lines. There’s no time to waste. Lives are at stake.

Addiction is a disease, not a choice. Substance misuse is a chronic disease. I am pleased that information on our collective effort with the Massachusetts dental schools is being published in this month’s Journal of Dental Education.³ It is this kind of dissemination that will help curb the misuse of opioids in the U.S. and globally. We must continue to fight the syndemic—and help individuals, families, and our communities fight this terrible disease and related infections. Dental educators and students are vital to winning this battle.