Dentists take bite out of opioid epidemic
On opioids, the news can seem all bad.
But quietly, and without spending a dime, Multnomah County has slashed in half the number of pain pills prescribed at dental health clinics serving 25,000 low-income patients a year.
Official records shared with The Outlook show the number of prescriptions for opioids and high-strength sedatives plunged 46 percent in two years across the county dental system.
One prescriber, whose name was not included for privacy reasons, went from writing 176 high-risk prescriptions in 2014 to just five in 2016.
The change — largely unheralded outside government board rooms — will undoubtedly help protect community members from an addictive epidemic that kills 142 Americans every day.
"I've never worked in a place where people care more about patients' welfare," says Dr. Len Barozzini, who spearheaded the policy shift. "We, as a nation, have a long way to go."
Barozzini has served as county dental director for almost four years, overseeing about 40 dentists and 130 total employees located in six health centers, five sited east of the Willamette River.
The largest clinic, with 13 chairs, is located at the East County Health Center on Eighth Street in Gresham. Another bustling clinic off 182nd Avenue aids Rockwood residents.
The county dental system's overall decline in Schedule II drugs, which Ohare classified as having a "high potential for abuse" by the federal government, was from 2,727 scripts in 2014 to just 1,473 scripts in 2016.
Now, opioid prescriptions can no longer include a refill at the first consultation. Patients can return for another visit if they think they need more medication.
Providers are also required to ask the patient questions about their addiction history, and document the conversation in the person's file.
"The dentists did all the work. I may have been the mouthpiece, but I got complete buy in," emphasizes Barozzini, an L.A. expat with a glinting smile. "The high prescribers I've had talks with — they're not high prescribers anymore."
Unliked 31 other states, physicians in Oregon don't legally have to check the secure database that records all prescriptions given to each person. But Barozzini expects county dentists to log-in to the system, called the Oregon Prescription Drug Monitoring Program.
That cuts down significantly on what's called "doctor shopping," Barozzini says.
"The patients who come in (wanting too many opioids), I don't think they're trying to screw the dental program. I think they have an addiction," he adds.
Opioids can cause serious health problems, and don't relieve chronic pain very effectively when used for long periods, according to a patient handout distributed by the Multnomah County Health Department. They're not much use for what's known as acute pain either.
Acute pain is a sharp hurt with a specific cause, like a rotten tooth that needs extraction. Patients want it remedied — and in a hurry, which is understandable — even though the pain may only last for a few days or weeks.
Chronic pain is different. It lasts for months, and may not have an easily identifiable solution.
Dentists, Barozzini notes, are almost always treating acute pain. And there's no evidence from clinical studies suggesting opioids are more effective at combating acute aches than regular over-the-counter painkillers.
"Opioids actually don't work as well as ibuprofen or acetaminophen in conjunction with an antibiotic," he explains. "(But) patients don't think they've gotten legitimate treatment unless they walk out of the doctor's office with something strong."
An easy workaround is to prescribe pills with 600 or 800 milligrams of ibuprofen in each capsule, which requires a prescription. But really, it's no different than popping four OTC pills that have 200 milligrams each.
Roughly 10 percent of Multnomah County residents use the public system of primary care, dental and pharmacy centers — though if your income is above the federal poverty line, you may have never stepped foot inside one.
About 85 percent of patients have Medicaid, and the others are uninsured. The legislation known as ObamaCare greatly expanded the rolls of citizens who have access to government-subsidized insurance plans like CareOregon or Delta Dental.
County dental clinics are "soup to nuts" joints, Barozzini describes, equally adept at fillings, root canals, sealants and fluoride varnishes for kids, plus the regular deep cleanings performed by dental hygienists.
"To serve the underserved, or those not served at all," Barozzini says. "That's our mission."