Division of Epidemiology, Services and Prevention Research, National Institute on Drug Abuse, Rockville, MD, USA.
J Am Dent Assoc. 2011 Jul;142(7):800-10. doi: 10.14219/jada.archive.2011.0268.
Opioids are analgesics that have potential for misuse, abuse or addiction. Up to an estimated 23 percent of prescribed doses are used nonmedically. As prescribers of 12 percent of immediate-release (IR) opioids in the United States, dentists can minimize the potential for misuse or abuse.
The authors participated in a two-day meeting in March 2010 cohosted by Tufts Health Care Institute Program on Opioid Risk Management, Boston, and Tufts University School of Dental Medicine, Boston. The purpose of the meeting was to synthesize available opioid abuse literature and data from a 2010 survey regarding West Virginia dentists' analgesic prescribing practices, identify dentists' roles in prescribing opioids that are used nonmedically, highlight practices that dentists can implement and identify research gaps.
Dentists can play a role in minimizing opioid abuse through patient education, careful patient assessment and referral for substance abuse treatment when indicated, and using tools such as prescription monitoring programs. Research is needed to determine the optimal number of doses needed to treat dental-related pain.
Dentists cannot assume that their prescribing of opioids does not affect the opioid abuse problem in the United States. The authors suggest that dentists, along with other prescribers, take steps to identify problems and minimize prescription opioid abuse through greater prescriber and patient education; use of peer-reviewed recommendations for analgesia; and, when indicated, the tailoring of the appropriate and legitimate prescribing of opioids to adequately treat pain. Practice Implications. The authors encourage dentists to incorporate practical safeguards when prescribing opioids, consistently educate patients about how to secure unused opioids properly, screen patients for substance use disorders and develop a referral network for the treatment of substance use disorders.
阿片类药物具有潜在的误用、滥用或成瘾风险。据估计，高达 23%的处方剂量被非医疗使用。作为美国 12%即释（IR）类阿片类药物的处方者，牙医可以最大限度地减少潜在的误用或滥用风险。
作者参加了 2010 年 3 月由塔夫茨医疗保健研究所阿片类药物风险管理项目和波士顿塔夫茨大学牙医学院共同主办的为期两天的会议。会议的目的是综合现有的阿片类药物滥用文献和数据，以及 2010 年关于西弗吉尼亚州牙医止痛药物处方实践的调查，确定牙医在非医疗使用阿片类药物处方中的作用，强调牙医可以实施的做法，并确定研究空白。
牙医可以通过患者教育、仔细的患者评估和在需要时转介进行药物滥用治疗，以及使用处方监测计划等工具，在最大限度地减少阿片类药物滥用方面发挥作用。需要研究确定治疗与牙齿相关疼痛所需的最佳剂量。
牙医不能认为他们开的阿片类药物不会影响美国的阿片类药物滥用问题。作者建议牙医与其他处方者一起采取措施，通过更多的处方者和患者教育、使用同行评议的止痛建议，以及在需要时，适当调整阿片类药物的处方，以充分治疗疼痛，从而识别和最小化处方阿片类药物滥用问题。实践意义。作者鼓励牙医在开阿片类药物处方时纳入实际的保障措施，始终向患者教育如何妥善保管未使用的阿片类药物，筛查患者的药物使用障碍，并建立一个药物使用障碍治疗的转诊网络。
