The ADA Practical Guide to Substance Use Disorders and Safe Prescribing

239 Pages·2015·13.43 MB·English

by  O'Neil

The ADA Practical Guide to
Substance Use Disorders and
Safe Prescribing
AndrewTaylorO’Neil(September2,1991–September9,2014)
ThisbookisdedicatedtoAndrew–high-schoolvaledictorian,EagleScoutwithhighesthonors,nat-
uralist,intellectual,humorist,friendandteachertoall,brother,andmostimportantlyanamazing,
caring,giving,andlovingson.NoparentcouldeverbemoreproudofasonthanIamofyou.You
areforeverintheheartsofallthatevermetyou.
Dad
The ADA Practical
Guide to Substance
Use Disorders and
Safe Prescribing
Edited by
Michael O’Neil, PharmD
Professor and Vice-Chair, Department of Pharmacy Practice
Drug Diversion, Substance Abuse, Pain Management Consultant
South College School of Pharmacy
Knoxville, TN, USA
Copyright©2015byAmericanDentalAssociation.Allrightsreserved
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LibraryofCongressCataloging-in-PublicationData
TheADApracticalguidetosubstanceusedisordersandsafeprescribing/editedbyMichaelO’Neil.
p.;cm.
Practicalguidetosubstanceusedisordersandsafeprescribing
AmericanDentalAssociationpracticalguidetosubstanceusedisordersandsafeprescribing
Includesbibliographicalreferencesandindex.
Summary:“Thisisinadditiontoavarietyoflegalregulationsdentistsmustfollowregardingthestorageand
recordkeepingofcontrolledsubstances”—Providedbypublisher.
ISBN978-1-118-88601-4(paperback)
I.O’Neil,Michael(Pharmacist),editor. II.AmericanDentalAssociation,issuingbody. III.Title:Practicalguide
tosubstanceusedisordersandsafeprescribing. IV.Title:AmericanDentalAssociationpracticalguidetosubstance
usedisordersandsafeprescribing.
[DNLM:1.DentalCare–UnitedStates. 2.Substance-RelatedDisorders–UnitedStates. 3.Dental
Offices–organization&administration–UnitedStates. 4.Dentist-PatientRelations–UnitedStates.
5.DrugPrescriptions–standards–UnitedStates. 6.DrugandNarcoticControl–UnitedStates.WM270]
RK701
617.6061–dc23 2015006921
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10 9 8 7 6 5 4 3 2 1
Contents
Contributors xi
Preface xiii
Acknowledgments xv
1 Substance Use Disorders, Drug Diversion, and Pain Management:
The Scope of the Problem 1
MichaelO’Neil,PharmD
Introduction 1
Definitions 2
SubstanceUseDisorder,DrugMisuse,DrugDiversion,
andPainManagementintheDentalCommunity 4
UnderstandingtheCulturesofSubstanceUseDisorder,DrugMisuse,andDrugDiversion 8
Summary 9
References 10
2 Understanding the Disease of Substance Use Disorders 11
JamesH.Berry,DOandCarlRollynnSullivan,MD
Introduction 11
Definitions 11
Epidemiology:Drug/Alcohol 13
Pathophysiology/BrainPathways 14
Signs,Symptoms,Behavior 15
TreatmentMethods 20
Summary 26
v
vi Contents
Appendix2.A:CommonOpioidAnalgesicsandtheirBrandNames 27
References 29
ResourcesandFurtherReadings 30
3 Principles of Pain Management in Dentistry 31
PaulA.Moore,DMD,PhD,MPHandElliotV.Hersh,DMD,MS,PhD
Introduction 31
Definitions 32
NeurophysiologyandNeuroanatomyofAcuteInflammatoryPain 32
OrallyAdministeredAnalgesicAgents 33
Medication-AssistedTherapiesforTreatingDrug-DependentPatients 41
AdjunctiveDrugsUsedtoLimitPaininDentistry 41
GuidelinesforAnalgesicTherapy 43
Summary 45
References 45
ResourcesandFurtherReadings 46
4 Special Pain Management Considerations: (1) Chronic Methadone,
Buprenorphine, and Naltrexone Therapy; (2) Chronic Opioids for
Nonmalignant Pain 47
MichaelO’Neil,PharmD
Introduction 47
Definitions 48
InterviewingthePatient:EstablishingGoalsofTreatment 49
PharmacologicalTreatmentofOpioidAddiction 49
TreatingAcuteDentalPain 51
AcutePaininPatientsReceivingOpioidMaintenanceTherapy 51
TheActiveOpioidAddict 55
AcutePainManagementinPatientsReceivingNaltrexoneTherapy 56
AcutePainManagementinPatientsReceivingOpioidsforChronicPain 57
Summary 57
References 58
5 Sedation and Anxiolysis 61
MatthewCooke,DDS,MD,MPH
Introduction 61
Definitions 61
SpectrumofAnesthesiaandSedation 62
PreoperativeEvaluation 64
PhysicalStatusClassification 65
Sedation 65
MedicationsAvailableforSedationofPatientswithSubstanceUseDisorder 68
TheConceptofBalancedAnesthesia 76
MonitoringandDocumentation 76
Summary 78
Disclaimer 78
References 79
ResourcesandFurtherReadings 82
Contents vii
6 Common Substances and Medications of Abuse 83
WilliamJ.Maloney,DDSandGeorgeF.Raymond,DDS
Introduction 83
Definitions 83
SignsandSymptomsofSubstanceUseDisorder 85
CommonSubstancesofAbuse 86
PrescriptionMedications 100
Over-the-CounterMedications 111
Summary 112
References 112
ResourcesandFurtherReadings 118
7 Tobacco Cessation: Behavioral and Pharmacological
Considerations 119
FrankVitale,MAandAmandaEades,PharmD
Introduction 119
Definitions 119
FormsofTobacco 121
OralEffectsofTobaccoUse 121
DentalPractitionerManagementofTobaccoUse 122
SpitTobaccoInterventions 124
OralSubstitutes 125
SocialSupport/Disapproval 125
MedicationManagementforSmokingCessation 126
TheRoleofNicotine 126
PharmacotherapyOptions 127
Summary 138
References 138
ResourcesandFurtherReadings 140
8 Detection and Deterrence of Substance Use Disorders
and Drug Diversion in Dental Practice 141
SarahT.Melton,PharmD,BCPP,BCACP,CGP,FASCPandRalphA.Orr
Introduction 141
Definitions 141
ScreeningPatientsforSubstanceUseDisorder 142
SchemesandScamstoObtainPrescriptionDrugs 144
DentalPractitioner-andOfficePersonnel-RelatedPrescriptionDrugDiversion 147
PrescriptionDrugMonitoringPrograms 148
DisposalofControlledSubstances 153
UniversalPrecautionsinPrescribingControlledSubstances 154
Summary 157
References 157
ResourcesandFurtherReadings 158
viii Contents
9 Interviewing and Counseling Patients with Known or Suspected
Substance Use Disorders: Dealing with Drug-seeking Patients 159
GeorgeF.Raymond,DDSandWilliamJ.Maloney,DDS
Introduction 159
Definitions 160
PreinterviewConsiderations 160
PatientInterviewConsiderations 161
InterviewingandCounselingTechniques 162
WhatQuestionsShouldBeAsked? 163
ScreeningTools 164
Documentation 165
Summary 166
References 166
ResourcesandFurtherReadings 167
10 Office Management of Controlled Substances 169
CarlosM.Aquino
Introduction 169
FederalStatutesandRegulations 169
Definitions 169
CommonViolationsbyDentalPractitioners 170
SurvivingaDrugEnforcementAdministrationInspection 173
PracticeDueDiligenceProgram 175
ManagementofNoncontrolledSubstancesintheOffice 176
Summary 176
ResourcesandFurtherReadings 176
11 Addiction and Impairment in the Dental Professional 177
WilliamT.Kane,DDS,MBA,FAGD,FACD
Introduction 177
Definitions 178
TheComplexityofAddiction 178
TheNeurobiologyofAddiction 179
TheStigmaofAddiction 180
EpidemiologyofAddictioninDentistry 180
RiskFactorsforSubstanceUseDisorder 180
SubstancesofChoice 182
IdentifyingAddiction 183
“TheConspiracyofSilence” 183
Intervention 184
Evaluation/Assessment 185
Treatment 186
FamilyandStaff 186
Relapse 187
Monitoring 187
PeerAssistanceorDentalWell-beingCommitteePrograms 187