Tuesday, July 30, 2019

Clarification of New Opioid Prescribing Recommendations for the State of Missouri

 


Attempts to curb opioid and opiate prescribing across the board are being pursued by both states and the federal government.  While dentistry has not been a major source of the opioid problem, mainly because we deal with acute rather than chronic conditions, it’s still smart to examine every source.

Along those lines, the State of Missouri (which is where my practice is located) recently passed some new legislation to help deal with the pain pill epidemic.

Unfortunately, the news cycle being what it is, there was almost instantly confusion and media reporting was both confusing and in many cases incorrect.  To help all doctors in the field understand exactly what is required, the Missouri Dental Association published the following statement to members in order to clarify the situation"

Since Governor Parson signed Senate Bill 514, media outlets have been saturating the public with how they perceive the statute to read. Also since then, the MDA has received many emails and calls expressing concerns and questions regarding the prescriptions of opioids by dentists. As you know, the MDA supports efforts to address the opioid epidemic in Missouri and nationwide. Therefore, the MDA worked with the Missouri Dental Board on its language addressing the opioid crisis and offered our full support on its legislation.

There are some common misconceptions that the MDA feels need to be addressed given the large amount of concerns and inquires.
The statute does not limit the specific medication that a dentist can prescribe. The statute states that long-acting or extended-release opioids shall not be used for the treatment of ACUTE pain, UNLESS it is necessary in the professional judgement of the dentist. It then requires that you document that necessity.
The language also states that dentists should avoid doses greater than 50 morphine milligram equivalent (MME) per day for treatment of ACUTE pain, UNLESS in the professional judgment, and again the dentist shall document. The Missouri Dental Board will be posting an MME conversion chart in order to help dentists with other alternatives for acute pain management outside of the use of opioids (and we will alert dentists once this is posted).
The purpose of this legislation was to address the opioid crisis plaguing the country from a dental front while not tying the hands of dentists from properly treating patients, and to give dentists an avenue for other options for acute pain management. The purpose of this language was NOT to put dentists in a position to have their license removed by the Missouri Dental Board for prescribing any opioid, as many of the articles are portraying.

Please feel free to reach out to the MDA Legislative and Regulatory Director, Shantel Smith, with any questions or concerns you may have at shantel@modentalmail.org.

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