If you suspect patients are struggling with substance abuse problems, your dental practice may be able to help. Here's how.
Take a Complete Health History and Ask About Substance Abuse
Both new and established patients within your dental practice need to update their complete medical history with you. You can use this opportunity to ask about substance abuse issues. When you ask patients if they smoke cigarettes or use alcohol, you can also ask about illicit drug use and if they have a history of abusing prescription medication in the past.
Be sure to tailor your language to include prescription drugs; many people don't view them as "illegal" if they're getting them from a doctor, even if they are abusing them. While you won’t always get an honest answer, asking may open up a dialogue for those that are ready or open to talking about it.
Discuss the Use of Opioid Pain Medication As a Last Resort
Prescription pain medication is often needed after many dental procedures, such as root canals and dental implants. Dental pain tends to be severe, but unfortunately, treating it with opioid pain medication can lead to substance abuse. Discuss the differences between narcotic and non-narcotic pain medicine and talk about why the American Dental Association (ADA) recommends the use of over-the-counter pain relievers like acetaminophen or ibuprofen as the first line of defense before using opiates like Lortab, OxyContin, and Percocet. Let your patients know that your dental practice only prescribes opiates on a case by case basis.
Reassure Your Patients That You'll Manage Their Dental Pain
If your patients hear that your goal is to avoid prescribing narcotic pain medication, they may be frightened that their pain will be poorly managed after their dental procedure. Take a few minutes to reassure your patients that you will treat their pain and will consider all available options when pain is severe. Let them know you care about their experience and will work with them to ensure they have safe, effective pain relief while reducing the risk of substance abuse as much as possible.
Refer Patients Struggling with Substance Abuse to a Professional
In the course of your career as a dentist, you'll likely run into more than one patient actively struggling with a substance abuse problem. They may be abusing prescription drugs or engaging in illegal drug use, the evidence of which may be apparent in their oral health. Many dentists avoid discussing substance abuse with their patients for fear of offending them, however, you can do so within the context of their treatment without shaming or upsetting them.
Offer your patient understanding and compassion when discussing substance abuse. Ask them permission to refer them to a behavioral health professional or substance abuse specialist.
Stay Up-to-Date On Changing Laws and Guidelines
The use of narcotic pain medications in dentistry is evolving and it's important that your practice stay abreast of new laws and guidelines that may affect how you prescribe pain medicine to your patients. Check local, state, and federal guidelines regarding the use of prescription pain medication in dentistry often and change your office policies as necessary to comply. You may also want to review with a local attorney who can advise about any legal requirements.
Use Your State's Prescription Drug Monitoring Software
Most, if not all, states now have controlled drug monitoring software that tracks what type of prescriptions patients fill, how often they fill them, and where they fill them. This helps prevent patients struggling with substance abuse from getting multiple prescriptions of controlled medications and filling them at different pharmacies. The software works to connect doctors and pharmacies with each other, so each can monitor how a patient is using controlled medicines. If you don't have access to a prescription monitoring database, ask your IT provider for assistance. You may want to check the database prior to prescribing controlled drugs; you may also want to prescribe a different medicine to patients who have a history of filling multiple prescriptions at different pharmacies. Or, you may want to monitor the narcotic usage of patients with ongoing treatment.
Dealing with a Patient Who Has a Substance Abuse Problem? Show Compassion and Care
The key to handling dental patients with substance abuse issues is often to show them care and compassion like you would any other patient, if not more so. Addiction is challenging and many people who struggle with substance abuse also struggle with mental health disorders and childhood trauma.
Let them know that you care about their well-being and that you're invested in their health. Spend one-on-one time with your patients and don't pressure them to divulge information they're uncomfortable sharing. Instead, focus on creating a doctor-patient relationship built on trust; your patient may eventually talk to you about substance abuse and allow you to offer help, even if it's not immediate.
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Treloar & Heisel, Inc. and its divisions do not offer legal or substance abuse advice. Please consult a professional concerning these topics.