Opioid Safety, Respiratory Compromise

Why Number of Opioid Prescriptions Written May Not Be as Important as Patient Assessment and Monitoring

The NY Times recently reported:

“After years of relentless growth, the number of opioid prescriptions in the United States is finally falling, the first sustained drop since OxyContin hit the market in 1996 … Experts say the drop is an important early signal that the long-running prescription opioid epidemic may be peaking, that doctors have begun heeding a drumbeat of warnings about the highly addictive nature of the drugs and that federal and state efforts to curb them are having an effect.

Decline in Opioid Prescriptions. Source: http://www.nytimes.com/2016/05/21/health/opioid-prescriptions-drop-for-first-time-in-two-decades.html?_r=0

Decline in Opioid Prescriptions. Source: http://www.nytimes.com/2016/05/21/health/opioid-prescriptions-drop-for-first-time-in-two-decades.html?_r=0

#Opioid Prescriptions Drop for First Time in Two Decades via @nytimes http://nyti.ms/256CDVX Click To Tweet

However, although this decline may be an indication of a “peaking” in the opioid epidemic, Pain Medicine News in an article, “Opioid Prescribing by Dentists After Tooth Extraction Found Likely Excessive” reports on a study by Brian Bateman, MD (Associate Professor of Anesthesia, Harvard Medical School) and his colleagues:

“Among the leading prescribers of opioids for pain relief, a new study has found that dentists’ prescriptions for opioids after tooth extractions are often for too long and for too many pills.

#Opioid Prescribing by Dentists After Tooth Extraction Found Likely Excessive via @painmednews http://goo.gl/3SrqF2 Click To Tweet

The Pain Medicine News article is a reminder that the prescribing of opioids is not just a numbers game. As the study notes, the appropriateness of the prescription is critical:

Although a limited supply of opioids may be required for some patients following tooth extraction, these data suggest that disproportionally large amounts of opioids are frequently prescribed given the expected intensity and duration of postextraction pain, particularly as nonopioid analgesics may be more effective in this setting.

In short, the better question may not be how many prescriptions have been written, but how well has the patient been assessed to determine appropriateness of dosage and strength, and when receiving opioids, how well is the patient monitored to ensure its safe use?

When prescribed #opioids, how well is the patient monitored to ensure safe use? #patientsafety #healthcare Click To Tweet

In tomorrow’s blog, we will discuss recent guidelines from the American Academy of Pediatrics (AAP) and the American Academy of Pediatric Dentistry (AAPD) for the monitoring and management of pediatric patients.

 

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