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Crystal Stinson

EDHP 504
Microteaching Presentation
Prescription drug abuse is now more deadly that
heroin and cocaine combined. This is the result
of the purity of the active ingredient achieved by
pharmaceutical companies. This is also due to
the patient considering prescription drugs to be
safe because a doctor prescribed them.

Because dentists notoriously are known for
prescribing narcotic analgesics without the
patient coming in for a doctors visit or when a
patient has a toothache they are frequently
targeted by drug seekers.
The most abused dental analgesics are
Hydrocodone and Oxycontin which are both
opioid based analgesics.
Opioid analgesics are in the same family as
heroin, a schedule 1 illegal substance of abuse.
Hydrocodone, a Schedule Two analgesic, is the
most widely abused prescription medication in
the United States. ER visits for hydrocodone
abuse have increased 500% since 1990

Hydrocodone is a semi-synthetic opiod
derived from codiene.
It is a weak agonist on opioid-receptors in the
CNS and decrease the activity of pain
Abuse is caused by the extreme euphoria as a
result of increased dopamine release due to
binding of the drug to the opiate receptors in
the reward pathway of brain.
Assertive personality, often demanding immediate action
Unusual appearance-extremes of either slovenliness or being
Knowledge of medications and symptoms, or evasive or vague answers
to history questions
Reluctance to provide reference information like address, insurance
information and name of regular doctor
Patient requests a specific controlled drug
Patient exhibits mood disturbances or suicidal thoughts.
The patient must be seen right away
The patient waits until evening or night to call for a problem they have
had all day
The patient states he/she is from out of town-traveling through, visiting
friends or relatives
Says that specific non-narcotic analgesics do not work, or that he/she is
allergic to them
Contends he is unable to get an appointment with a primary physician
States that a prescription has been lost or stolen and needs to be
Pressures the practitioner by eliciting sympathy or guilt, or by direct

Withdrawal symptoms start in 6-12 hours after the
last dose.

Day 1: diarrhea, extreme fatigue, nausea
Day2: extreme sweating and chills, feeling of
crawling out of skin, insomnia, diarrhea,
Day3: aches and pains all over body, anxiety, loss of
appetite, diarrhea, insomnia, watery eyes
Day 4-7: extreme pain in all areas of body, violent
shaking, stomach cramps, irregular heart beat,

Withdrawal symptoms usually subside in 7-10 days but
depending on length of abuse can go for 2-3 weeks.
Medicine abuse has become a real problem in our communities, Dr. William R. Calnon, ADA
president, said in a media release announcing the multi-pronged efforts. As prescribers of
narcotic pain medications, dentists are well positioned to educate patients about how to keep
these drugs from becoming a source of harm.
The ADA has developed or recognized several continuing education modules for dentists to
refresh their knowledge about opioid prescribing, Dr. Calnon and Dr. Kathleen OLoughlin, ADA
executive director, said in a related letter to constituent and component dental societies. The
content includes tips about cautious opioid prescribing and counseling parents about proper at-
home storage and disposal of unused medications. Dentists can also learn how to recognize signs
that a patient may be seeking opioid medications for non-medical purposes and what to do when
that occurs.
We hope you will consider sharing these resources with our tripartite members and, especially,
urge them to talk with their patients about how to safely secure and dispose of unused

Continuing Education Opportunities
The Association partnered with five other health professional organizations to provide free, easily
accessible, evidence-based trainings on the safe and appropriate prescribing of opioids, along
with a peer support network to help prescribers engage in safe opioid prescribing. Dentists can
obtain continuing education credits by completing webinars offered through the Prescribers
Clinical Support System for Opioid Therapies (PCSS-O).
CE no fee courses at ADAs 2012 annual session in San Francisco will include Management of the
Chemically Dependent Patient Oct. 18 and Clues to Your Patients Health: The Most Commonly
Prescribed Physician-Prescribed Medications Oct. 21. Related courses are scheduled for ADAs
Sept. 19-20, 2013 Dentist Health and Wellness Conference.
Drug-seeking behavior has changed dramatically in recent years, said Dr. Calnon. For that
reason, we are also urging dentists to refresh their knowledge about opioid prescribing in the
context of modern-day drug seeking behavior.

Drug Take-Back Day
The Association partnered with the Drug Enforcement Administration to promote DEAs fifth
National Prescription Drug Take-Back Day Sept. 29 for safe disposal of unused, unwanted and
expired medications at participating collection sites throughout the country.
Dentists are well positioned to educate parents about how to prevent teen prescription drug
abuse, the Association said in a letter to DEA Administrator Michele Leonhart. Over two-thirds
of Americans visit a dentist at least once a year. Dentists can use those visits to educate parents
how to properly secure and dispose of unused pharmaceuticals and recognize signs of abuse in
their children. This is especially true of dentists who prescribe medications to manage post-
operative pain.
Dentists must register with the Drug Enforcement Administration for authorization to prescribe
controlled substances.

Medicine Abuse Project
The Association offered strong support for the Partnership for DrugFree.orgs Medicine Abuse
Project, a multi-year educational effort to raise awareness about the dangers of medicine abuse.
Prescription medicines are now the most commonly abused drugs among 12- and 13-year-olds
and are second to marijuana among young adults, according to 2010 data from the Substance
Abuse and Mental Health Services Administration. Studies indicate these drugs often are
obtained from a friend, family member or the home medicine cabinet.
When used as prescribed, narcotic pain medications are safe and effective at minimizing post-
operative pain, Dr. Calnon said. But using them for any other purpose is illegal, dangerous and
can even be fatal. The ADA encourages patients or their care givers to visit the Medicine Abuse
Project website to learn more about how to prevent medication abuse.

All prescriptions should be limited to 15 or
less pills for post-operative pain.
No prescription pain killers should be
prescribed over the phone to non-patients of
Turn to NSAIDs before opioid drugs for
Educate patients on the risk of addiction and
overdose with opioid pain killers
A patient of record comes into your office with a
tooth ache and radiographic evidence of caries
approximating the pulp. The patient complains
of extreme spontaneous pain that keeps them
up at night and sensitivity to cold. The tooth is
non-restorable and needs to be extracted,
however the patient cannot afford this
treatment at the time. The patient request
analgesics until she can afford the extraction.
What would you do and why?
Have resources for known addicts. For pregnant
women abusing opioids or the medically
compromised the withdrawal period can be fatal
to the user and/or the developing fetus. Patients
angry about being denied a prescription can also
file complaints so address the situation
professionally and document encounters. I know
it may be easier to prescribe medication instead
of seeing a patient in emergency. Some doctors
think Its just a few pills but with the new trends
of IV and snorting opioids overdose is more
likely to occur and more likely to be deadly.
Any Questions?