Dental schools adopt strategy to combat opioid abuse

OxyContin pills.Toby Talbot/AP/file 2013

The three dental schools in Massachusetts have agreed to teach skills in managing pain, prescribing painkillers, and detecting improper use of those drugs, as part of the effort to combat the state’s opioid crisis.

Governor Charlie Baker announced the initiative Thursday. It follows a similar agreement in November among the four medical schools in the state, which adopted a curriculum aimed at equipping doctors to prevent and respond to abuse of powerful drugs.

“I’m proud that our state is once again setting a new standard by providing our [dental] students with a strong foundation and education with respect to pain management,” Baker said.

The dental schools’ agreement highlights the critical role of dentists in addressing the opioid crisis, which claimed more than 1,200 lives last year.

Dentists prescribed about 8 percent of opioids in 2009, the third highest-prescribing profession (after general practitioners and internists). Treating pain is a routine aspect of dental practice, with patients coming in with toothaches or leaving with temporary pain from dental procedures. And the dental office can be a point of entry into the health care system.

“Dentists are in a particularly unique position to have an impact, as they typically have regular contact with their patients and commonly address issues of preventive health and wellness in their oral health regimes,” said Dr. R. Bruce Donoff, dean of the Harvard School of Dental Medicine, in a statement.

The 2,350 students who combined attend the schools — Harvard dental, Boston University Henry M. Goldman School of Dental Medicine, and Tufts University School of Dental Medicine — will be required to master a defined set of key skills. The schools developed the curriculum in conjunction with the Massachusetts Department of Public Health and the Massachusetts Dental Society.

Under the agreement, dental students will learn how to evaluate patients’ pain as well as their risk for abusing drugs, and how to discuss the pros and cons of pain treatments. They will also be trained to recognize the signs of inappropriate drug use and to practice pain management.

The curriculum will train and encourage dentists to counsel patients and collaborate with other health professionals, two areas relatively new to dental practice.

“By and large, dentists work in a little isolated situation,” said Dr. David Keith, cochairman of the Governor’s Dental Education Working Group and professor at the Harvard dental school. “They must become comfortable with communicating with their colleagues.”

Although the schools already teach some of these skills, the agreement ensures that all three incorporate instruction in each of the skills, so that every graduate is educated in opioid use and misuse. The dental schools will incorporate the new material into existing courses rather than creating courses, officials said, possibly starting in the current academic year.

“Previous generations have sort of reached for the prescription pad as a first line of treating the patient,” Keith said. “If the prescription pad only contains opioids, that’s not a good thing.”

Most pain from dental procedures is short-lived, Keith said, and yet patients routinely receive prescriptions for 30 Vicodin even after minor procedures. Leftover pills stashed in medicine cabinets can easily be stolen by teenagers and visitors for their own use or sale on the street.

Dentists trained in the new curriculum will have better understanding of the expected pain level from a procedure, the best way to manage it, and the discussions they should have with patients, Keith said. Additionally, they will know how to recognize “red flags” in patients who may be misusing drugs and how to discuss it with them in a way that is not judgmental.

“We need a sea change so that all dentists from all backgrounds can have this open conversation,” he said.

The other cochairman of the working group, Ronald J. Kulich, a Tufts professor, said because dentists are constantly addressing pain issues, they have a potentially influential role in detecting and helping troubled patients.

Marylou Sudders, the state health and human services secretary, said the Massachusetts dental schools were paving the way for the rest of the country. “I know the deans will be speaking to deans across the country as well as publishing in their journals,” she said. Additionally, she said, Massachusetts dental school graduates who practice in other states will set an example putting into practice what they learned here.

Current dentists will also benefit from the initiative, said Dr. Raymond K. Martin, a Mansfield dentist and president-elect of the Massachusetts Dental Society. The society, he said, is working with the dental schools and the state on developing continuing education courses in pain management and substance abuse that are tailored to dental practice.