Presented at our February 10th meeting by Dr. Angela Rake and Dr. Patrick Ebeling
Synopsis Written by P. Angela Rake, DDS

Opioid analgesics are one of the most frequently prescribed drugs by both physicians and dentists. As dentists (oral and maxillofacial surgeons included) we prescribe approximately 12% of all immediate-release opioids in the United States, second only to Family Practice at 15%. A recent report showed that dentists are the most frequent prescribers of opioids for patients between the ages of 10 and 19. Prescribing behaviors bears a responsibility in the misuse/abuse diversion and addiction of opioids. I covered that not only do we have an obligation but a responsibility to be part of the solution, and the solution in my opinion is re-education. As healthcare providers, we have a responsibility to acknowledge the role and the obligation to develop solutions to address the opioid epidemic. A shift towards evidence-based mandated guidelines for the treatment of mild to moderate or severe acute postoperative pain origin is needed to achieve this goal. The role of the pharmaceutical industry through their infiltration into our education, and influence on regulatory agencies and how this altered prescription opioid prescribing was also shown. An overview was provided of a multimodal approach to postoperative pain management. The lecture included an overview of the opioid epidemic, the state of the opioid epidemic in both Minnesota and globally in the United States, discussion of prescriber’s role and behavior, and also solutions in communication. Again, in summary, it is my plea as a surgeon, wife, daughter, mother and fellow human being that we re-educate ourselves and change prescribing patterns to help prevent adverse outcomes to both patients and our community.

Review Written by Marilyn Wesphal, BSN, RN, CNOIR

In addition to the facts presented above, Dr. Angela Rake also shared more alarming statistics along with her personal family story that engaged the audience. Dr. Rake is grieving the loss of a brother who is still alive. He is on an unrecoverable path. She wrote an article for the Journal of Oral Maxillofacial Surgery in 2016. Her brother was a successful graduate of Pepperdine University Law School and landed his dream job at the age of 26. Four months later, he was diagnosed with testicular cancer and became physically addicted to opioids. He never recovered and is a heroin addict living on the streets of Seattle.Did you know that in 2016, 64,000 people died from opioid overuse?

Did you know WHO is dying from opioid overdose in MN? They are white males, 45-54 years old and they are dying in their own homes. There is an exponential growth in drug overdose deaths that has to stop! It has been declared an epidemic and a National Health Care Emergency. Every year over 300 million opioid prescriptions are written. What has led to this crisis?  Drugs, Money and Power…she demonstrates it’s the influence and money of the pharmaceutical industry. In 2001, JCAHO identified pain as the “fifth vital sign” to heart rate, temperature, respirations, and blood pressure. Pain management education was then introduced by the drug companies NOT the medical providers. More and more push and influence from the drug companies and soon you see the impact on MD prescribing behaviors.

MD prescribing behaviors are this: 99 % prescribe longer than CDC guideline; 74% believe oxycodone / morphine are the most effective for treating pain; 71% of pts receive rx for back pain; 55% of pts receive rx for dental procedures; of 99% of “pill seeking patients” only 32% are referred on for treatment; 67% of prescribers base the rx on the patients expectations; 58% are victims of rx fraud or theft; 33% did not ask about drug habits or addiction before prescribing more; and 41% expected that patients would have leftover drugs to manage.

Dr. Rake has changed her prescribing practices and has instituted an educational “Opioid Prescription Patient Agreement” to be signed by the patient or parent of a minor. She has also found her voice on a National level. Just google her on “Youtube” to hear round table discussions and her speaking platforms. It’s worth your time!

Youtube Link