Dental Tribune America

Interview: “Dental professionals have a front-line opportunity to help combat the opioid epidemic”

By Dental Tribune International
July 23, 2019

The opioid epidemic that is gripping the U.S. is a major concern for many health care professionals. Studies suggest that U.S. dentists prescribe up to 30% more opioids than their English colleagues and that many people addicted to opioids first came into contact with the drugs through friends and family and not through clinicians. At the moment, there is a great deal of information on the topic and some findings are conflicting. To gain clarity on the issue, Dental Tribune International spoke with Dr. David Hamlin, a regional dental director at Cigna.

Dr. Hamlin, can you explain a little bit about Cigna and the role it plays within the health care and dental industry?
Cigna is a global health service company that delivers choice, predictability, affordability and access to quality care through integrated capabilities and personalized solutions that advance whole-person health, including medical, dental and behavioral health. Cigna also provides pharmacy and supplemental benefits and other related products.

The fastest growing national dental carrier, Cigna has over 16 million dental customers and a network of over 146,000 dental providers offering innovative solutions to help people maintain and improve oral health. The company’s approach to oral health is founded on evidence-based clinical insights that provide oral care programs alongside a personalized experience to educate and empower Cigna customers to manage their whole health—body and mind.

Recently, you spoke about the role dentistry has to play in combating the opioid epidemic that is currently gripping the country. Can you elaborate?
Dentists play an important role in preventing the misuse of opioids and addiction to them, especially among teenagers and young adults. The highest number of new opioid prescriptions in the dental profession are written for teenagers after oral surgery, yet they are at higher risk of opioid dependency than adults, because their brains are still developing. In fact, young people aged 18–25 are 6.8% more likely than adults to develop an opioid addiction within one year of being prescribed opioids for third molar extractions.[1]

While no one entity can solve this crisis alone, dental professionals have a front-line opportunity to help combat the opioid epidemic by prescribing safer and more effective alternative treatments for treating acute dental pain and by improving the coordination and quality of care for people who are taking opioids.

A recent study found that U.S. dentists prescribe 37 times more opioids than their English colleagues, do you think there is a problem around the culture of opioid prescription within the profession?
We have not seen evidence that U.S. dentists prescribe opioids to patients at levels that would suggest a “culture of opioid prescription”. In our experience, dentists support appropriate prescribing, and we have seen significant decreases in strength and days supplied within the Cigna dental network.

What is Cigna doing to help cultivate more awareness in dentistry about the issues of opioids?
We partner with dental providers to support the appropriate use of opioids to manage pain effectively. With this aim in view, we develop continuing education materials that share best practices, communicate to our dental network through an e-newsletter and advocate safer alternative strategies for dental pain management.

We are also leveraging our integrated dental and pharmacy data and analytics to drive prevention, early intervention and the creation of long-term solutions in partnership with providers. Our recent analysis of Cigna customers with dental and pharmacy benefits revealed a 19% reduction in opioid (morphine milligram equivalent) prescriptions and a 9% reduction for opioid days’ supply across dental specialists in the Cigna network.

At the 2019 International Association for Dental Research General Session and Exhibition, it was mentioned that Cigna is exploring research and partnerships with technology companies to evaluate the role of digital pain management. Can you tell us a little more about this?
We see an opportunity to use a variety of digital approaches to continue to measure and support pain management when the patient is away from the dental office. For instance, we are looking at digital applications for patients to share their pain experience and communicate unresolved pain issues after third molar extractions so that appropriate intervention may occur.

At present, what are some of the better alternatives to opioids available for dentists? While every patient’s situation is unique, the pain from most dental procedures can be managed without opioids. In fact, nonsteroidal anti-inflammatory drugs, such as Advil and ibuprofen, are actually a better option—they manage pain more effectively and also treat inflammation.

If an oral health professional wanted to better inform himself or herself on the issue of opioids, what would your suggestion be?
We strongly recommend that dental professionals continue to stay informed on current standards of care supported by evidence-based research through dental associations and public health agencies, such as the Centers for Disease Control and Prevention (CDC). According to the CDC, three days or less of a short-acting opioid is generally expected to resolve dental pain. In addition, Cigna has a Help with Pain website that provides pain management information and resources for patients and providers.

[1]Schroeder AR, Dehghan M, Newman TB, Bentley JP, Park KT. Association of opioid prescriptions from dental clinicians for US adolescents and young adults with subsequent opioid use and abuse. JAMA Intern Med. 2019 Feb 1;179(2):145–52.

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