By Kyla Romard
NSDA Clinical Affairs Manager

The opioid crisis continues to pose a significant public health challenge in Canada, with thousands of lives lost each year due to opioid overdoses. According to recent statistics, the number of opioid-related deaths has surged, with synthetic opioids, particularly fentanyl, contributing to a significant proportion of these fatalities. The crisis is driven by a combination of factors, including over-prescription of opioids, lack of awareness about the risks, and the availability of illicit substances.

As dental professionals, ensuring patient safety and effective pain management is at the forefront of our practice. With growing concerns about opioid misuse, it is essential for dentists to adopt responsible prescribing habits and to adhere to established guidelines. The Provincial Dental Board of Nova Scotia (PDBNS) has outlined specific recommendations for prescribing opioids in its document, “Guidelines for Prescribing Opioids and Benzodiazepines in Dental Practice.” The purpose of this article is to provide a concise overview of these guidelines to support dentists in making informed decisions regarding pain management in patients.

Opioid prescribing guidelines

Indications for use: Opioids should be prescribed only when absolutely necessary and typically only for acute pain management. For most dental procedures, over-the-counter analgesics or non-opioid prescription medications (such as ibuprofen, acetaminophen, ketorolac, and, in some cases, long-acting local anesthetics) should be considered as first-line treatments.

Patient assessment: It is important to conduct a thorough history and physical examination, obtain diagnostic imaging when appropriate, and make a diagnosis before prescribing any pain therapy, including opioids. In cases where an opioid is indicated, a social history reviewing the patients psychiatric and substance abuse history (including any previous instances of opioid use) should be documented.

Prescription duration: Limit the quantity of opioid prescriptions to the minimum necessary duration. Short-term prescriptions of three to four days are usually sufficient for managing post-operative pain. If the patient requires opioids beyond this time frame, they should be reassessed clinically prior to being prescribed more opioids.

Dosage and potency: Prescribe the lowest effective dose and consider using lower-potency opioids where appropriate. Long-acting or extended-release opioids should not be prescribed unless the dentist has specialized training and experience.

Monitoring and follow-up: Schedule follow-up appointments to assess the patient’s progress and adjust the pain management plan as needed. Monitor for signs of misuse and educate patients on the proper use and disposal of opioids.

Patient education: Inform patients of the risks associated with opioid use, including potential side effects and signs of dependence. Provide guidance on alternative pain management strategies and emphasize the importance of adhering to prescribed doses.

General best practices

• Record keeping: Maintain accurate and detailed records of all prescriptions, including the rationale for prescribing, dosages, and patient responses. This documentation is crucial for monitoring patient care and complying with regulatory requirements.
• Implement prescription monitoring: Be aware of your province’s prescription monitoring programs. In Nova Scotia, all dentists are encouraged to sign up and use eAccess (a service provided by the prescription monitoring program [PMP] of Nova Scotia). eAccess is a resource which provides prescribers and pharmacists with timely access to information they need to determine the best treatment for patients while promoting the appropriate use and the reduction of abuse and misuse of monitored drugs. Information on registering for eAccess can be found online.
• Collaborate with other healthcare providers: When necessary, work with physicians, pharmacists, and mental health professionals to ensure a multidisciplinary approach to patient care. This collaboration can help identify patients at risk for substance misuse and provide comprehensive support.
• Stay informed: Stay updated on the latest guidelines and research related to opioid prescribing. Continuing education and training can help ensure that your prescribing practices remain aligned with current best practices and regulatory standards.

By adhering to the guidelines set forth by the Provincial Dental Board of Nova Scotia, dentists can help mitigate the risks associated with opioid use while still providing effective pain management for their patients. It is our responsibility to balance pain relief with patient safety and to promote practices that support the well-being of our community.

For further details, including a more in-depth review on acute pain, pharmacology, dosage recommendations, and more, please refer to the PDBNS resource, “Guidelines for Prescribing Opioids and Benzodiazepines in Dental Practice.”