Oral Health Program: Opioids and Substance Use Disorders

Data were sourced from the Prescription Drug Monitoring Program (PDMP) database using only opioid prescriptions written by dental providers from 2013-2021. Data suppression was used to protect provider confidentiality. Data suppression was enforced for any county with a single prescriber within a given year. For example, if County X had one prescriber in 2013 and two prescribers in 2014, then its 2013 data would be excluded from the dashboard, but its 2014 data would be included. Measures included in the dashboard represent yearly averages by county. See description of each measure outlined below.

• Prescriptions per Prescriber: Average number of prescriptions written by prescribers 
• Days Supply per Prescription: Average number of days a prescription would last written by prescribers
• Morphine Milligram Equivalents (MMEs) per Prescription: Average number of MMEs per prescription written by prescribers
• Daily Dosage per Prescription (MMEs/Day): Average daily dosage per prescription written by prescribers

 

• Comprehensive Approach to Dental Pain Management in the Evolving Substance Use Disorder Epidemic – Marquette University School of Dentistry and DHS training – 2 CE dental credits: Two part training on pharmacologically sound pain control strategies and the origins of dental pain for all dental professionals based on the science and available literature. Focused on alternatives to narcotic pain medications and understanding the issues associated with prescription opioid misuse. Additional training is provided on risk factors for substance use disorder, trauma and trauma-informed care, and the harmful effects of stigmatizing language and behavior. The training will improve the participants’ use and understanding of the Wisconsin ePDMP.
• Opioids and Children and Adolescents: Information for Oral Health Professionals – National Maternal and Child Oral Health Resource Center publication: Describes recent research and best practices for pain management in children and adolescents, and where to find more evidence-based resources.
• Oral Analgesics for Acute Dental Pain – ADA: Provides information on managing acute dental pain with nonopioid analgesic options. The section on Selecting an Acute Pain Management Strategy provides a table of anticipated post procedural pain levels and a table of oral analgesic options for treating acute dental pain based on pain level from mild to severe.
• Prescribing Opioids for Women of Reproductive Age: Information for Dentists – National Maternal and Child Oral Health Resource Center publication: Describes best practices for pain management in pregnant women, guidelines for prescribing opioids, and a description of neonatal opioid withdrawal syndrome.
• Wisconsin Dentistry Examining Board Best Practices for Prescribing Controlled Substances Guidelines – Wisconsin Department of Safety and Professional Services (DSPS) publication: This publication is Wisconsin Dentistry Examining Board's legal guidance to dentists for prescribing controlled substances.
• Wisconsin Enhanced Prescription Drug Monitoring Program – DSPS: The ePDMP tool helps combat the ongoing prescription drug abuse epidemic in Wisconsin, provides valuable information about controlled substance prescriptions dispensed in the state; aids healthcare professionals in their prescribing and dispensing decisions; and fosters the ability of pharmacies, healthcare professionals, law enforcement agencies, and public health officials to work together to reduce the misuse, abuse, and diversion of prescribed controlled substance medications. Remember, register a delegate and simplify your process for checking the ePDMP before writing a patient prescription.

Did you check the Wisconsin ePMDP?

People, Health, Dignity, Respect

Respecting a person's health and dignity can happen through conversation. Some conversations may feel difficult, but avoiding stigmatizing language, using trauma-informed practices, and motivational interviewing techniques can help.

• Introduction to Motivational Interviewing – University of Wisconsin (UW) Health training – 1 CE credit: Motivational Interviewing (MI) is a collaborative, goal-oriented style of communication with particular attention to the language of change. It is designed to strengthen personal motivation for, and commitment to, a specific goal by eliciting and exploring the person's own reasons for change within an atmosphere of acceptance and compassion. With the use of modules and skill building, this course provides an introduction to MI, followed by the Foundation and Four Processes of MI.
• Introduction to Trauma Informed Care (TIC) – The Department of Health Services (DHS) and UW training: This learning module defines and identifies types of trauma, explains the significance of the Adverse Childhood Experiences study and its impact in the advent of TIC, explains resilience and resilience concepts, defines TIC, recognizes the five principles of TIC culture, and differentiates between traditional substance use disorder recovery practices and trauma-informed recovery practices.
• Substance Use Disorders: Showing Support and Having Hard Conversations Part 1 DHS training- 1 CE credit: Stephanie Botts, RDH, BSDH, will help the entire oral health care team show support and address hard conversations with patients or a team member surrounding Opioid use or SUD.  Participants will; understand SUD as a treatable medical condition; be able to recognize physical and psychological changes consistent with SUD; know the importance of avoiding stigmatizing language; and be able to communicate effectively with compassion and understanding.  
• Substance Use Disorders: Showing Support and Having Hard Conversations Part 2 DHS training- 1 CE credit: Sean Mahoney, CRM PSS, PWS, will relate the patients' point of view surrounding the oral health experience and having hard conversations. Participants will understand: how lived experience and personal attitudes affect patients' access to oral health care services; how Opioid and cocaine use affect oral health, and the trauma surrounding poor oral health; Trauma Informed Care and how it reduces harm for patients; and stigmatizing language and how to avoid it. Participants will also learn how to locate helpful National and Wisconsin-specific resources.

Words matter - guide for choosing your words

Anyone may use substances, use illegal drugs, or misuse prescription medications when they are seeking pain relief or still experiencing cravings. Understanding that people are people first and avoiding stigmatizing language is one way to show respect. 

Don’t say this: Addict, junkie, drunk, pill popper, pill head
Say this instead: Person with a substance use disorder, Person with a ____(e.g., alcohol, benzodiazepine, chemical, opioid, etc.) use disorder

Don’t say this: Dirty UA, dirty drug screen
Say this instead: Positive drug screen

Don’t say this: Drug abuse
Say this instead: Drug use, substance use, medication misuse

Don’t say this: Drug-seeking
Say this instead: Still experiencing cravings, seeking pain relief

Don’t say this: Ex-addict, former addict
Say this instead: Person in recovery, person in remission

Don’t say this: Habit
Say this instead: Substance use disorder, ____ (e.g., alcohol, benzodiazepine, chemical, opioid, etc.) use disorder

Don’t say this: Reformed addict
Say this instead: Previously used ____ (e.g., alcohol, benzodiazepines, chemicals, opioids, etc.), in recovery, in remission 

Don’t say this: Relapsed, slipped
Say this instead: Returned to use

Don’t say this: Stayed clean
Say this instead: Maintained recovery

• Dose of Reality: Resources for Professionals – DHS: More information on Wisconsin's Opioid Epidemic and prevention, getting help now, data, and additional resources for professionals.
  • NARCAN® is widely available in Wisconsin. Learn more about the NARCAN® Direct Program that provides free NARCAN® for community distribution.
  • The Fentanyl Test Strip Direct Program provides free fentanyl test strips for community distribution.
• Oral Health, Mental Health and Substance Use Treatment: A Framework for Increased Coordination and Integration – National Council for Mental Wellbeing: "Challenges with oral health, mental health and substance use are exceedingly common in the United States and contribute heavily to the burden of disease in the nation." Toolkit provides a guide for health professionals to increase coordination and integration efforts across oral, mental health, and substance use treatment settings; offers suggestions, strategies, and on-the-ground examples for implementation of new care models across health systems.
• Substance Abuse and Mental Health Services Administration (SAMHSA) – U.S. Department of Health and Human Services: SAMHSA leads public health efforts to advance the behavioral health of the nation. Use this website to locate information about treatment options, practitioner training, public messages, grant funding opportunities, data, programs, news and more.
• Substance Use: Provider Information – DHS: A webpage for health care professionals who provide substance use disorder services and are seeking support and direction to treat patients with substance use issues. Find information on hotlines, data, rules and regulations, and professional training opportunities.