Oral surgeon changes prescribing practices because of addiction story
When Dr. David Kimberly, an oral surgeon in Akron, heard about the overdose of ODA Vice President Dr. Sharon Parsons’ son, it affected him personally.
“It was a slap in my face when I saw that a young person who is a family member of someone I care about was injured as a direct result of the types of medications that I am responsible for prescribing,” Kimberly said. “After stepping outside of my training and reflecting on my prescribing habits, I wondered ‘am I really doing what’s best for my patients and the community?’”
Kimberly decided to do an audit of the prescriptions he was writing, and he said the numbers he found were alarming.
“Our practice made a decision that we were going to start cutting back on the narcotics prescribed,” he said. “We have gone from prescribing 30 tabs of Percocet down to eight now for an average set of wisdom teeth. We also prescribe five days’ worth of ibuprofen. What we have found is that our patients now are actually in less pain than when they were relying on the narcotics alone. We’re not just obtunding them with narcotics; we’re actually treating the cause of their pain.”
Kimberly said he now uses both NSAIDs and Tylenol to their maximum efficacy and he relies on narcotics as a rescue medication if needed. His practice has also increased patient education with regard to pain control, and often this starts with the “Start Talking” informed consent form that parents or guardians must sign for minors. He talks about using narcotics as a rescue and about what to expect after surgery.
“We are altering the expectations of patients. Knowledge is power. Knowing what to expect alleviates a lot of anxiety,” he said.
Kimberly said the response from his patients has been very positive.
“The parents are ecstatic,” he said. “The patients are much much happier because they are not sick to their stomach, and they’re getting better pain relief. I don’t hear from patients as often for insomnia, nausea and pain. It’s amazing.”
He said now when he does get a call about pain, it’s a red flag that something might be wrong so he has the patient come into the office.
Kimberly encourages other dentists to take a hard look at their prescribing practices and consider prescribing fewer narcotics.
“Sometimes the training that you received doesn’t keep up with the realities of current practice and current patient needs,” Kimberly said. “Don’t be hesitant to change your prescribing practices for fear that you’re not going to alleviate your patients’ discomfort. The combination of patient education and effective use of non-narcotic pain control measures is extremely potent, and everyone’s surgical experience benefits, including your own.”
Looking for more information about opioid prescribing and addiction?
Attend “The Heroin Epidemic, Prescription Drug Abuse and Your Practice” from 10 a.m. to noon Sept. 15 at the ODA Annual Session. Register and learn more at www.oda.org/events with course code S70.