Nội dung của công việc này chỉ nhằm mục đích tiếp tục nghiên cứu, hiểu biết và thảo luận về khoa học nói chung và không nhằm mục đích và không được dựa vào việc khuyến nghị hoặc quảng bá một phương pháp, chẩn đoán hoặc điều trị cụ thể của các nhà khoa học sức khỏe cho bất kỳ bệnh nhân cụ thể nào. Nhà xuất bản và tác giả không tuyên bố hoặc bảo đảm về tính chính xác hoặc đầy đủ của nội dung của tác phẩm này và từ chối đặc biệt tất cả các bảo đảm, bao gồm nhưng không giới hạn bất kỳ bảo đảm ngụ ý nào về tính phù hợp cho một mục đích cụ thể. Theo quan điểm của nghiên cứu đang diễn ra, sửa đổi thiết bị, thay đổi trong các quy định của chính phủ và luồng thông tin liên tục liên quan đến việc sử dụng thuốc, thiết bị và dụng cụ, người đọc được khuyến khích xem xét và đánh giá thông tin được cung cấp trong tờ hướng dẫn sử dụng hoặc hướng dẫn cho mỗi loại thuốc, thiết bị hoặc dụng cụ, trong số những thứ khác, bất kỳ thay đổi nào trong hướng dẫn hoặc chỉ dẫn sử dụng cũng như các cảnh báo và biện pháp phòng ngừa bổ sung. Độc giả nên tham khảo ý kiến của bác sĩ chuyên khoa ở những nơi thích hợp. Việc một tổ chức hoặc Trang web được đề cập đến trong tác phẩm này là nguồn thông tin bổ sung hoặc nguồn thông tin tiềm năng không có nghĩa là tác giả hoặc nhà xuất bản xác nhận thông tin mà tổ chức hoặc Trang web có thể cung cấp hoặc khuyến nghị mà tổ chức hoặc Trang web có thể đưa ra. Hơn nữa, độc giả nên biết rằng các Trang Web được liệt kê trong tác phẩm này có thể đã thay đổi hoặc biến mất giữa thời điểm tác phẩm này được viết và khi nó được đọc. Không có bảo hành nào có thể được tạo ra hoặc mở rộng bởi bất kỳ tuyên bố quảng cáo nào cho công việc này. Cả nhà xuất bản và tác giả đều không chịu trách nhiệm về bất kỳ thiệt hại nào phát sinh từ đây.
www.pdflobby.com The ADA Practical Guide to Substance Use Disorders and Safe Prescribing www.pdflobby.com Andrew Taylor O’Neil (September 2, 1991–September 9, 2014) This book is dedicated to Andrew – high-school valedictorian, Eagle Scout with highest honors, naturalist, intellectual, humorist, friend and teacher to all, brother, and most importantly an amazing, caring, giving, and loving son No parent could ever be more proud of a son than I am of you You are forever in the hearts of all that ever met you Dad www.pdflobby.com 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 www.pdflobby.com Copyright © 2015 by American Dental Association All rights reserved Published by John Wiley & Sons, Inc., Hoboken, New Jersey Published simultaneously in Canada No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning, or otherwise, except as permitted under Section 107 or 108 of the 1976 United States Copyright Act, without either the prior written permission of the Publisher, or authorization through payment of the appropriate per-copy fee to the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, (978) 750-8400, fax (978) 750-4470, or on the web at www.copyright.com Requests to the Publisher for permission should be addressed to the Permissions Department, John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, (201) 748-6011, fax (201) 748-6008, or online at http://www.wiley.com/go/permission The contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting a specific method, diagnosis, or treatment by health science practitioners for any particular patient The publisher and the author make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of fitness for a particular purpose In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions Readers should consult with a specialist where appropriate The fact that an organization or Website is referred to in this work as a citation and/or a potential source of further information does not mean that the author or the publisher endorses the information the organization or Website may provide or recommendations it may make Further, readers should be aware that Internet Websites listed in this work may have changed or disappeared between when this work was written and when it is read No warranty may be created or extended by any promotional statements for this work Neither the publisher nor the author shall be liable for any damages arising herefrom For general information on our other products and services or for technical support, please contact our Customer Care Department within the United States at (800) 762-2974, outside the United States at (317) 572-3993 or fax (317) 572-4002 Wiley also publishes its books in a variety of electronic formats Some content that appears in print may not be available in electronic formats For more information about Wiley products, visit our web site at www.wiley.com Library of Congress Cataloging-in-Publication Data The ADA practical guide to substance use disorders and safe prescribing / edited by Michael O’Neil p ; cm Practical guide to substance use disorders and safe prescribing American Dental Association practical guide to substance use disorders and safe prescribing Includes bibliographical references and index Summary: “This is in addition to a variety of legal regulations dentists must follow regarding the storage and record keeping of controlled substances”—Provided by publisher ISBN 978-1-118-88601-4 (paperback) I O’Neil, Michael (Pharmacist), editor II American Dental Association, issuing body III Title: Practical guide to substance use disorders and safe prescribing IV Title: American Dental Association practical guide to substance use disorders and safe prescribing [DNLM: Dental Care–United States Substance-Related Disorders–United States Dental Offices–organization & administration–United States Dentist-Patient Relations–United States Drug Prescriptions–standards–United States Drug and Narcotic Control–United States WM 270] RK701 617.6061–dc23 2015006921 Cover images (clockwise from top middle): © iStockphoto/JurgaR; © iStockphoto/mphillips007; © iStockphoto/KarenMower; © iStockphoto/Bunyos; © Stephen Wagner, used with permission Set in 9.5/12pt Palatino LT Std by Aptara Inc., New Delhi, India Printed in Singapore 10 www.pdflobby.com Contents Contributors xi Preface xiii Acknowledgments xv Substance Use Disorders, Drug Diversion, and Pain Management: The Scope of the Problem Michael O’Neil, PharmD Introduction Definitions Substance Use Disorder, Drug Misuse, Drug Diversion, and Pain Management in the Dental Community Understanding the Cultures of Substance Use Disorder, Drug Misuse, and Drug Diversion Summary References Understanding the Disease of Substance Use Disorders James H Berry, DO and Carl Rollynn Sullivan, MD Introduction Definitions Epidemiology: Drug/Alcohol Pathophysiology/Brain Pathways Signs, Symptoms, Behavior Treatment Methods Summary 10 11 11 11 13 14 15 20 26 v www.pdflobby.com vi Contents Appendix 2.A: Common Opioid Analgesics and their Brand Names References Resources and Further Readings Principles of Pain Management in Dentistry Paul A Moore, DMD, PhD, MPH and Elliot V Hersh, DMD, MS, PhD 31 Introduction Definitions Neurophysiology and Neuroanatomy of Acute Inflammatory Pain Orally Administered Analgesic Agents Medication-Assisted Therapies for Treating Drug-Dependent Patients Adjunctive Drugs Used to Limit Pain in Dentistry Guidelines for Analgesic Therapy Summary References Resources and Further Readings 31 32 32 33 41 41 43 45 45 46 Special Pain Management Considerations: (1) Chronic Methadone, Buprenorphine, and Naltrexone Therapy; (2) Chronic Opioids for Nonmalignant Pain Michael O’Neil, PharmD Introduction Definitions Interviewing the Patient: Establishing Goals of Treatment Pharmacological Treatment of Opioid Addiction Treating Acute Dental Pain Acute Pain in Patients Receiving Opioid Maintenance Therapy The Active Opioid Addict Acute Pain Management in Patients Receiving Naltrexone Therapy Acute Pain Management in Patients Receiving Opioids for Chronic Pain Summary References 27 29 30 Sedation and Anxiolysis Matthew Cooke, DDS, MD, MPH 47 47 48 49 49 51 51 55 56 57 57 58 61 Introduction Definitions Spectrum of Anesthesia and Sedation Preoperative Evaluation Physical Status Classification Sedation Medications Available for Sedation of Patients with Substance Use Disorder The Concept of Balanced Anesthesia Monitoring and Documentation Summary Disclaimer References Resources and Further Readings www.pdflobby.com 61 61 62 64 65 65 68 76 76 78 78 79 82 Contents Common Substances and Medications of Abuse William J Maloney, DDS and George F Raymond, DDS Introduction Definitions Signs and Symptoms of Substance Use Disorder Common Substances of Abuse Prescription Medications Over-the-Counter Medications Summary References Resources and Further Readings Tobacco Cessation: Behavioral and Pharmacological Considerations Frank Vitale, MA and Amanda Eades, PharmD Introduction Definitions Forms of Tobacco Oral Effects of Tobacco Use Dental Practitioner Management of Tobacco Use Spit Tobacco Interventions Oral Substitutes Social Support/Disapproval Medication Management for Smoking Cessation The Role of Nicotine Pharmacotherapy Options Summary References Resources and Further Readings Detection and Deterrence of Substance Use Disorders and Drug Diversion in Dental Practice Sarah T Melton, PharmD, BCPP, BCACP, CGP, FASCP and Ralph A Orr Introduction Definitions Screening Patients for Substance Use Disorder Schemes and Scams to Obtain Prescription Drugs Dental Practitioner- and Office Personnel-Related Prescription Drug Diversion Prescription Drug Monitoring Programs Disposal of Controlled Substances Universal Precautions in Prescribing Controlled Substances Summary References Resources and Further Readings www.pdflobby.com vii 83 83 83 85 86 100 111 112 112 118 119 119 119 121 121 122 124 125 125 126 126 127 138 138 140 141 141 141 142 144 147 148 153 154 157 157 158 viii Contents Interviewing and Counseling Patients with Known or Suspected Substance Use Disorders: Dealing with Drug-seeking Patients George F Raymond, DDS and William J Maloney, DDS Introduction Definitions Preinterview Considerations Patient Interview Considerations Interviewing and Counseling Techniques What Questions Should Be Asked? Screening Tools Documentation Summary References Resources and Further Readings 159 159 160 160 161 162 163 164 165 166 166 167 10 Office Management of Controlled Substances Carlos M Aquino 169 Introduction Federal Statutes and Regulations Definitions Common Violations by Dental Practitioners Surviving a Drug Enforcement Administration Inspection Practice Due Diligence Program Management of Noncontrolled Substances in the Office Summary Resources and Further Readings 169 169 169 170 173 175 176 176 176 11 Addiction and Impairment in the Dental Professional William T Kane, DDS, MBA, FAGD, FACD Introduction Definitions The Complexity of Addiction The Neurobiology of Addiction The Stigma of Addiction Epidemiology of Addiction in Dentistry Risk Factors for Substance Use Disorder Substances of Choice Identifying Addiction “The Conspiracy of Silence” Intervention Evaluation/Assessment Treatment Family and Staff Relapse Monitoring Peer Assistance or Dental Well-being Committee Programs www.pdflobby.com 177 177 178 178 179 180 180 180 182 183 183 184 185 186 186 187 187 187 The ADA Practical Guide to Substance Use Disorders and Safe Prescribing Continuing Education Examination Name: Address: City: State: Zip: Phone (include area code): E-mail: To receive hours of continuing education credit, mail completed test to: American Dental Association Lockbox 28094 Network Place Chicago, IL 60673-1280 A $20 grading fee applies for each test mailed Please indicate your payment method below: Check (payable to American Dental Association) Visa MasterCard Credit card number American Express Exp date (mm/yy) Cardholder signature Tests are graded and responses mailed within a few days of receipt To check on the status of a test or for other test-related questions, call 800-947-4746 This test is intended for use by allied dental personnel as well as dentists Making copies of the blank test for use within a practice is acceptable The American Dental Association is an ADA CERP Recognized Provider Continuing education credits issued for participation in the CE activity may not apply toward license renewal in all licensing jurisdictions It is the responsibility of each participant to verify the CE requirements of his/her licensing or regulatory agency The ADA Practical Guide to Substance Use Disorders and Safe Prescribing, First Edition Edited by Michael O’Neil © 2015 American Dental Association Published 2015 by John Wiley & Sons, Inc 207 www.pdflobby.com 208 The ADA Practical Guide to Substance Use Disorders and Safe Prescribing Continuing Education Examination Please circle True or False for each question Chapter 1 The four common cultures of prescription drug diversion and substance use disorder based on the “intent” of the individual are: sharing culture, income-driven culture, substance abuse culture, and addiction culture TRUE FALSE Prescriber–patient mismatch is defined as the inconsistency in treatment goals or expectations of treatment between the prescriber and the patient Examples include analgesia, sedation, or anxiolysis TRUE FALSE Medication misuse may be defined as taking a prescribed or over-the counter (OTC) medication for nonprescribed purposes, in excessive doses, shorter intervals than prescribed or recommended, or for reasons other than the original intent of the prescription Examples include doubling the dosage, shortening dosing intervals, or treating disorders for which the medication was not prescribed TRUE FALSE In a patient suspected of having developed tolerance to a substance of abuse, less medication is usually required to achieve adequate sedation, analgesia, or anxiolysis, depending on the substance abused TRUE FALSE Dental practitioners should be cautious when administering benzodiazepines or barbiturates to patients with a history of alcoholism that are in recovery due to the potential to stimulate cravings TRUE FALSE Common signs and symptoms from withdrawal of stimulants such as methamphetamine and cocaine are seizures, hypertension, and slurred speech TRUE FALSE Chapter www.pdflobby.com Continuing Education Examination 209 Chapter Unless contraindicated due to renal disease, allergies, coagulopathies, major drug interactions, and so on, nonsteroidal anti-inflammatory drugs (NSAIDs) are second-line agents used in the treatment of acute dental pain TRUE FALSE In patients with liver disease that has been stable for several years, acetaminophen should always be avoided even with total daily doses less than g to treat acute dental pain TRUE FALSE In patients with no contraindications, a “preemptive strike” with NSAIDs 1–2 h before a major dental procedure should be considered for minimizing postprocedure pain and inflammation TRUE FALSE TRUE FALSE Patients receiving naltrexone (Vivitrol® ) 50 mg daily for opioid or alcohol addiction should have their naltrexone stopped 72 h before a procedure that will require treatment with opioids during or post procedure TRUE FALSE In patients receiving daily, around-the-clock opioids for chronic nonmalignant pain, a patient’s same daily dosages of opioids will likely treat the acute pain from the dental procedure FALSE Chapter 10 11 12 Patients receiving single daily doses of methadone or buprenorphine for opioid maintenance treatment should not be given additional opioid treatment of any kind since the single daily doses of methadone or buprenorphine provide adequate analgesia for most of the day www.pdflobby.com TRUE 210 The ADA Practical Guide to Substance Use Disorders and Safe Prescribing Chapter 13 14 15 When performing surgical procedures on a patient with a known or suspected history of recent methamphetamine or cocaine abuse, epinephrine-containing products should be avoided due to the potential for life-threatening cardiovascular events such as dysrhythmias, hypertension, or ischemia TRUE FALSE Minimal sedation (historically known as anxiolysis) is defined as a drug-induced state during which patients respond normally to verbal commands Although cognitive function and coordination may be impaired, ventilatory and cardiovascular functions are unaffected TRUE FALSE Ideally, when selecting anesthesia agents for a patient with a history of substance use disorder those agents should have limited potential to stimulate or provoke cravings TRUE FALSE Patients reporting to a dental practitioner that they have recently used “bath salts” should anticipate similar adverse effects seen with stimulants or cannabis substances TRUE FALSE Prescription medications that are commonly abused include antipsychotics, muscle relaxants, and anticonvulsants owing to their side effect profile being similar to alcohol TRUE FALSE OTC products like pseudoephedrine or dextromethorphan are not likely to be abused since current commercial products have minimal concentrations of these substances in each tablet or bottle TRUE FALSE Chapter 16 17 18 www.pdflobby.com Continuing Education Examination 211 Chapter 19 20 21 All tobacco education occurring at the dental practitioner’s office should be done by the dentist TRUE FALSE To optimize the likelihood of tobacco cessation quitting success, nicotine replacement therapy should be done in conjunction with counseling and/or behavior modification TRUE FALSE Nicotine gum products are easy to use for tobacco cessation since patients should “chew” these products constantly exactly like chewing gum without “parking” the gum between the cheek and teeth when effects of the gum are detected orally TRUE FALSE SBIRT is an evidence-based practice used to identify, reduce, and prevent problematic use, abuse, and dependence on alcohol and illicit drugs TRUE FALSE After printing a prescription drug monitoring program patient profile or report, immediate observations of aberrant patterns of prescription refills for opioids are definitive evidence of a crime TRUE FALSE One of the most common illegal activities of dental practitioners is prescribing outside the scope of dental practice TRUE FALSE Motivational interviewing is a short-term, directive, patient-centered TRUE style of counseling to help explore and resolve ambivalence FALSE When interviewing patients, open-ended questions should be used to help prevent patients from “shutting down the interviewer” with simple yes or no responses TRUE FALSE “Disarming the patient” at the beginning of the dental office interview is a strategic goal to minimize a patient’s fears of the possible dental practitioner’s responses to the patient’s answers TRUE FALSE Chapter 22 23 24 Chapter 25 26 27 www.pdflobby.com 212 The ADA Practical Guide to Substance Use Disorders and Safe Prescribing Chapter 10 28 29 30 If a dental practitioner wants to dispense individual dosages (e.g 10–12 dosage units) of hydrocodone products to several patients from the dental office, the dental practitioner can legally obtain a bulk bottle of hydrocodone products with a single prescription and then dispense the products to multiple patients TRUE FALSE Due diligence is the practice of performing reasonable verification that the information presented is accurate and reliable in order to prevent deceptive or criminal practices Reasonable implies that the practitioner is doing what any practitioner would and should in the routine activities of the health-care professional TRUE FALSE According to federal regulations involving controlled substances, the term “Readily retrievable” means records should be able to be produced on site within two business days TRUE FALSE Drug or alcohol relapse “IS” an instantaneous event of reusing a substance of abuse TRUE FALSE Impairment may be defined as the inability to consistently think rationally, perform job-related tasks, or communicate effectively without reoccurring error while performing job-related activities TRUE FALSE “The Conspiracy of Silence” is a common series of behaviors in which family, staff members, and colleagues are wary of bringing the addicted dental practitioner’s problem to light TRUE FALSE Chapter 11 31 32 33 www.pdflobby.com Index Page numbers in italics denote figures, those in bold denote tables acamprosate 23 acetaminophen (APAP) 34, 35, 42, 67, 73 dosage 45 opioid combinations 27, 31, 39 pain relief 44 precautions and contraindications 36 acetylsalicylic acid (aspirin) 34 precautions and contraindications 36 active listening 160 acupressure 64 acupuncture 64 acute inflammatory pain 2, 31, 32–3, 32, 33 Adderall® see dextroamphetamine addiction culture definition 2, 11–12, 178 medical model 12 neurobiology 179–80 in practitioners 177–90, 204–5 conspiracy of silence 183–4 epidemiology 180 evaluation and assessment 185 family and staff involvement 186–7 identification 183 intervention 184–5 monitoring 187 peer assistance/dental well-being committee programs 187–9 relapse 187 risk factors 180–2 substance of choice 182–3 treatment 186 recognition of 178–9, 179 stigma of 180 addiction support programs 188 aerosols 95–6 age, and SUD 13–14 alcohol abuse 6, 89, 97–8, 201 and benzodiazepines 196 blood alcohol concentration 16, 16 dental considerations 99 and liver disease 198, 202 in practitioners 182–3 signs and symptoms 6, 15–16, 16 treatment 22–3 withdrawal symptoms 16, 98 The ADA Practical Guide to Substance Use Disorders and Safe Prescribing, First Edition Edited by Michael O’Neil © 2015 American Dental Association Published 2015 by John Wiley & Sons, Inc 213 www.pdflobby.com 214 Index Alcohol Use Disorders Identification Test (AUDIT) questionnaire 165 Alcoholics Anonymous 21–2, 21 alfentanil 67 alpha agonists 67, 74–5 alprazolam 70, 108 ambivalence 12 American Psychiatric Association amobarbital 108 amphetamine 107 anabolic steroids 111, 111 analgesia see pain management anesthesia 62–4, 63 balanced 76 general 62 inhalation anesthetics 75, 75 local see local anesthetics stages of 63 Antabuse® see disulfiram anticholinergics 67 anticonvulsants 110 antihistamines 67, 74, 74, 111 antipsychotics 109 anxiolysis 61–2 see also sedation APAP see acetaminophen aspirin see acetylsalicylic acid Ativan® see lorazepam atropine 67 AUDIT see Alcohol Use Disorders Identification Test balanced anesthesia 76 barbiturates 67, 108–9 dental considerations 108 see also individual drugs “bath salts” see cathinones, synthetic behavioral coping 120 benzodiazepines 107–8, 108 addiction 16–17 treatment 23 withdrawal 17 adverse effects 70 and alcohol abuse 196 dental considerations 108 reversal 71 sedation 67, 69–71, 70 biofeedback 64 blood alcohol concentration 16, 16 brand switching 125 Buprenex® see buprenorphine buprenorphine 25, 26, 39, 50–1, 72, 106 acute dental pain in OMT patients 54–5 buprenorphine/naloxone 26, 39, 41 bupropion 131–2, 134–7 butalbital 109 butorphanol 26 CAGE questionnaire 143, 164 Campral® see acamprosate cannabinoids, synthetic 100 cannabis abuse 19, 78, 89, 98–9, 201 dental considerations 100 treatment 25 caries in heroin users 94 and smoking 121 carisoprodol 110 cathinones, synthetic 91 dental considerations 92 celecoxib 34, 35 Centers for Disease Control central nervous system depressants 97–8, 107–8, 107 see also individual drugs Chantix see varenicline chewing tobacco 121 chloral hydrate 67 chlordiazepoxide 70 cigarette smoking incidence 120 second-hand smoke 122 see also tobacco; tobacco cessation clonazepam 107 clonidine 67, 73 tobacco cessation 133 cocaine abuse 78, 86, 87, 90, 199 dental considerations 91 codeine 26, 39, 105–6 codeine/APAP 26, 39 cognitive behavioral therapy 21 www.pdflobby.com Index cognitive coping 119–20 Concerta® see methylphenidate consent or mandated programs 188 contingency management 21 Controlled Substance Act (1970) 103, 152, 169 controlled substances 101, 169–76 common violations 170–3 disposal 153–4, 171 documentation 171–3, 172, 174 Drug Enforcement Administration inspections 173, 175 due diligence 170, 175–6, 191 federal statues and regulations 169 record keeping 170, 171 prescriber controlled-substance reports 153 safe prescribing 202–4 storage 171 universal precautions 154–7 coping strategies behavioral coping 120 cognitive coping 119–20 corticosteroids 42–3 counseling 159–67 COX-2 inhibitors 34–5, 34 CRAFFT 165, 165 cross-addiction 12 cross-tolerance 48 cyclobenzaprine 110 deep sedation 62, 76 Demerol® see meperidine denial 178 dental practitioners see practitioners dental well-being programs 187–9 designer drugs 19–20 dexmedetomidine 67, 74 dextroamphetamine 18, 107 dextromethorphan 111 Diagnostic and Statistical Manual of Mental Disorders-IV see DSM-IV-TR diazepam 67, 70, 107–8 diclofenac 34 diclofenac/APAP 43 diflunisal 34 Dilantin® see phenytoin 215 diphenhydramine 67 dosage 74 dispensing 170 disulfiram 22 diversion behaviors 2–3, 6–7, 141–2 patients 144–7 in office 144–6 outside office 147 privacy of 152 practitioner/office personnel 147–8 prevention practices 146–7, 156–7 recognition of 192–4, 193 red flags 146 reporting of 150, 152, 194 doctor/dentist shopping 142, 145, 162 patient privacy 152 documentation controlled substances 171–3, 172, 174 motivational interviewing 165–6 see also record keeping Dolophine® see methadone dopamine beta-hydroxylase 23 Dormicum® see midazolam Drug Addiction Treatment Act (2000) 47–8 drug diversion see diversion behaviors Drug Enforcement Administration inspections 173, 175 drug misuse 2–3, 83 drug-seeking 160 diversion behaviors see diversion behaviors doctor/dentist shopping 142, 145, 162 DSM-IV-TR due diligence 170, 175–6, 191 ecstasy 20 electronic cigarettes 133 electronic dental anesthesia 64 ethanol see alcohol abuse etodolac 34 family history 181 fentanyl 26–7, 39, 67, 104 Flexeril see cyclobenzaprine Flumazenil® 71 Food, Drug, and Cosmetic Act 133 FRAMES mnemonic 20 www.pdflobby.com 216 Index gabapentin 110 gamma-hydroxybutyrate 98 gender, and SUD 13–14 general anesthesia 62 Geodon® see ziprasidone glucocorticoids 42 glue-sniffer’s rash 95 glycopyrrolate 67 Guedel, Arthur 62 inhalant abuse 19–20, 95–7 dental considerations 97 treatment 25 see also specific types inhalation anesthetics 75, 75 interviews see motivational interviewing intramuscular injection 67 intranasal administration 66 Halcion® see triazolam hallucinogen abuse 19–20, 91–4 dental considerations 93 treatment 25 see also individual drugs hashish 98–9 Health Insurance Portability and Accountability Act (1996) 149, 175 heroin abuse 88, 94–5, 94, 95, 200 dental considerations 96 histamines hookahs 121 huffing see inhalant abuse hydrocodone 27, 102–4, 104 drug interactions 103 hydrocodone/APAP 27, 31, 39, 43 dosage 45 hydrocodone/ibuprofen 39 hydromorphone 39, 104 hydroxyzine 67 dosage 74 hyperalgesia 48, 52, 57 hypnosis 64 hypnotics 67 iatrosedation 64 ibuprofen 34, 34 dosage 45 opioid combinations 39 pain relief 44 ibuprofen/APAP 44 illicit drug use impairment in dental practitioners 178, 204–5 potential causes 179 see also addiction income-driven culture ketamine 67, 72–3, 73, 110–11 adverse effects 73 ketoprofen 34 ketoprofen/APAP 43 ketorolac 34, 67, 73 khat 90 Klonopin® see clonazepam liver disease, and alcohol abuse 198, 202 local anesthetics 75–6 adverse reactions 76 long-acting 41–2 lorazepam 67, 70, 108 lovorphanol 27 LSD 20, 87, 92, 199 Luminal® see phenobarbital lysergic acid diethylamide see LSD marijuana see cannabis abuse MDMA 88, 92–3, 200 systemic effects 93 medical model of substance abuse 12 medication misuse 1, 5–6 medication-assisted therapy 12 medlofenamate 34 meperidine 27, 39, 67, 71 mescaline 20, 92 methadone 24, 39, 41, 50–1, 72, 104–5 acute dental pain in OMT patients 54–5 methamphetamine abuse 86, 87, 199 dental considerations 90 methohexital 67 3,4-methylenedioxymethamphetamine see MDMA methylphenidate 18, 107 Michigan Alcohol Screening Test 164 midazolam 67, 69–70, 70 www.pdflobby.com Index minimal sedation 61–2 moderate sedation 62, 76 morphine 27, 67, 71, 104 motivational interviewing 20, 159–67 definition 160 documentation 165–6 flag behaviors 162 preinterview considerations 160–1 questionnaires see questionnaires questions 161–2, 163–4 screening tools 164–5 techniques 162–3 active listening 160 mucosal atomization device (MADTM ) 66 muscle relaxants 75, 110 nalbuphine 39 naloxone 39 naltrexone 23, 25, 39, 51 and dental analgesia 56–7 depot 23, 25 Narcotic Drug Act (1932) 152 National Health and Aging Trends Study National Institute of Drug Abuse Drug Use Screening Tool 143–4 National Survey on Drug Use and Health neuromuscular blockers 75 Neurontin® see gabapentin neuropathic pain 2, 32 NicoDerm CQ 134–7 Nicorette 134–7 Nicorette Lozenge 134–7 nicotine addiction 19, 26, 126–7 withdrawal 127 see also tobacco; tobacco cessation nicotine fading 125 nicotine replacement therapy 120, 126, 127–38, 134–7 efficacy 130 formulations 131, 134–7 gum 128–9 inhaler 129–30 lozenges 129 nasal spray 130 patches 128, 128 product selection 130 217 nicotine toxicity 128 Nicotrol Inhaler 134–7 Nicotrol NS 134–7 nitrites 96–7 nitrous oxide abuse 68–9, 96 in practitioners 183 nociceptive pain 2, 31, 32 non-steroidal anti-inflammatory drugs see NSAIDs noncontrolled substances see over-the-counter drugs nonopioid analgesics 33–8, 34 COX-2 inhibitors 34–5, 34 drug interactions 36–7, 37 precautions and contraindications 35–6, 37 see also individual drugs nortriptyline 133 NSAIDs 7, 42 acute dental pain 51 drug interactions 37–8 ACE inhibitors, diuretics and beta-blockers 37 alcohol 37 anticoagulant therapy 37 lithium 38 methotrexate 38 precautions and contraindications 36 see also individual drugs OARS mnemonic 20 office staff, drug diversion behaviors 147–8 olanzapine 109 OMT see opioid maintenance therapy opiates see opioids opioids 3, 26–8, 38–41, 39, 83 adverse effects 40–1, 40, 72 for chronic pain 57 dependence see opioid dependence drug interactions 40–1, 40 sedation 71–2 opioid agonists 67 opioid antagonists 39 opioid dependence 3, 7, 17–18, 83, 88, 94–5, 94, 95, 101–2, 200 adjuvant therapy 73 adverse effects 102 www.pdflobby.com 218 Index opioid dependence (Continued) dental analgesia 55–6 dental considerations 103 intoxication 18 management see opioid maintenance therapy therapy goals 47, 49–50 withdrawal 18, 72 opioid maintenance therapy (OMT) 23–5, 24, 47, 48, 49–51 dental analgesia 51–5, 196–7 see also individual drugs opioid-based maintenance programs 72 opium 88, 94–5, 94, 95, 200 oral cancer 122 over-the-counter drugs 111–12, 176 see also individual drugs overprescribing oxycodone 28, 39, 102–4, 104, 202 drug interactions 103 oxycodone/APAP 27, 28, 39, 42, 44, 202 oxycodone/ibuprofen 39 oxymorphone 104 pain 31 acute 2, 31, 32–3, 32, 33 chronic 2, 31 neuropathic 32 nociceptive 2, 31, 32 pain fibers 33 pain management 1, 7–8, 31–46 active opioid addicts 55–6 acute dental pain 51 acute “on” chronic 198 adjunctive drugs 41–3 corticosteroids 42–3 long-acting local anesthetics 41–2 preemptive analgesics 42 ethical issues 194–6 guidelines 43–5, 44, 45 nonopioid 33–8, 34 OMT patients 51–5, 196–7 opioids see opioids patients on naltrexone therapy 56–7 patients receiving opioids for chronic pain 57 pain perception 49, 84–5 paints, sniffing 88, 95–6, 200 paracetamol see acetaminophen patient privacy 152 patient-centered approach 160 peer assistance programs 187–9 pentazocine 28, 39 pentazocine/APAP 39 pentazocine/naloxone 39 Percocet® see oxycodone/APAP perpetual inventory form 174 phencyclidine 92 phenobarbital 108–9 phenytoin 110 physical status classification 65 polypharmacy “poppers” see nitrites practitioners addiction in 177–90, 204–5 conspiracy of silence 183–4 epidemiology 180 evaluation and assessment 185 family and staff involvement 186–7 identification 183 intervention 184–5 monitoring 187 peer assistance/dental well-being committee programs 187–9 relapse 187 risk factors 180–2 substance of choice 182–3 treatment 186 definition 170 diversion behaviors 147–8 scope of practice 170–1 Precedex® see dexmedetomidine preemptive analgesia 42 pregabalin 73 preoperative evaluation 64 prescriber controlled-substance reports 153 prescriber-patient mismatch 3, 192 prescriptions 169–70 prescription drug monitoring programs 148–50, 159, 160, 193, 193 access to 153 case study 150, 151 prescription drugs 100–12 controlled substances see controlled substances misuse 1, 5–6, 84 www.pdflobby.com Index overdose overprescribing safe prescribing see safe prescribing seeker behavior 144–7 see also individual drugs prevention of drug diversion 146–7, 156–7 promethazine 67 propofol 67, 73 propoxyphene 40 prostaglandins pseudo-addiction 48 pseudoephedrine 18, 112 psilocybin 92 psychotherapeutic drugs psychotherapy 12 questionnaires see screening tools quetiapine 109 readily retrievable records 170, 171 ready-access list record keeping controlled substances 153, 170, 171 noncontrolled substances 176 relapse 187, 191 reporting to law enforcement 150, 152, 194 patient privacy 152 ReVia® see naltrexone Reye’s syndrome 36 Ritalin® see methylphenidate Romazicon® 71 safe prescribing 191–206 controlled substances 202–4 recognition of diversion behaviors 192–4, 193 reporting to law enforcement 150, 152, 194 Salvia divinorum 94 SBIRT see Screening, Brief Intervention, Referral for Treatment scope of practice 170–1 scopolamine 67 Screening, Brief Intervention, Referral for Treatment (SBIRT) 142–3, 164–5 screening tools 142–4, 152–3, 164–5, 165 AUDIT questionnaire 165 CAGE questionnaire 143, 164 CRAFFT 165, 165 219 Michigan Alcohol Screening Test 164 National Institute of Drug Abuse Drug Use Screening Tool 143–4 SBIRT 152–3, 164–5 sedation 61–82 available drugs 67 deep sedation 62 emergencies 77 iatrosedation 64 ideal 66 minimal sedation (anxiolysis) 61–2 moderate sedation 62 monitoring and documentation 76 physical status classification 65 preoperative evaluation 64 rescue 64 routes of administration 66 special considerations 77–8 spectrum of 63 SUD patients 68–76 benzodiazepines 69–71, 70 nitrous oxide-oxygen 68–9 self-report programs 188 Seroquel® see quetiapine sharing culture snuff 121 sodium thiopental 67 solvents 88, 95–6, 200 Soma® see carisoprodol spit products 120, 121 interventions 124–5 oral substitutes 125 stigma of addiction 180 stimulant abuse 18–19, 86, 90–1, 107 intoxication 18 tooth pain 197–8 treatment 25 withdrawal 19 see also individual drugs stress, and addiction 181–2 subcutaneous injection 67 Suboxone® see buprenorphine; buprenorphine/naloxone substance abuse 3, 84 culture 7–8 medical model 12 substance dependence 3–4 www.pdflobby.com 220 Index substance P substance use disorder (SUD) 1–2, 4–5, 11–29 age-related 13–14 brain pathways 14–15, 15 counseling patients 159–67 cultures of 8–9 definitions 11–13, 84 detection/deterrence 141–58 epidemiology 13–14 gender-related 13–14 pathophysiology 14–15, 15 in practitioners 177–90 risk factors 180–2 family history 181 stress 181–2 screening tools 142–4, 152–3, 164–5, 165 AUDIT questionnaire 165 CAGE questionnaire 143, 164 CRAFFT 165, 165 National Institute of Drug Abuse Drug Use Screening Tool 143–4 SBIRT 142–3, 164–5 symptoms 4, 15–20, 84, 85, 85 treatment 14, 20–8 behavioral modifications and counseling 20–2, 22 medications 22, 22 see also specific disorders Subutex® see buprenorphine SUD see substance abuse disorder tapentadol 28, 39 tobacco forms of 121 oral effects 121–2 see also nicotine addiction tobacco cessation 119–40 ask-advise-refer 122–3 blending 125 brand switching 125 creating a plan 123–4 electronic cigarettes 133 medication management 126 motivate-educate-refer 123 nicotine fading 125 oral substitutes 125 pharmacotherapy bupropion 131–2 clonidine 133 nicotine replacement therapy see nicotine replacement therapy nortriptyline 133 varenicline 132–3 resources 123 social support 125–6 spit products 124–5 tolerance 13, 84 tramadol 28, 40, 106 tramadol/APAP 28, 39 transtheoretical model of change 13, 13 triazolam 67, 70 universal precautions for controlled substances 154–7 Valium® see diazepam varenicline 132–3, 134–7 Versed® see midazolam Vicodin® see hydrocodone/APAP visual analog pain scale (VAPS) 49, 84–5 Vivitrol® see naltrexone withdrawal 13 alcohol 16 benzodiazepines 17 cannabis 19 nicotine 19 opioids 18 stimulants 19 Xanax® see alprazolam ziprasidone 109 Zubsolv® see buprenorphine Zyban see bupropion Zyprexa® see olanzipine www.pdflobby.com WILEY END USER LICENSE AGREEMENT Go to www.wiley.com/go/eula to access Wiley’s ebook EULA www.pdflobby.com ... Cataloging-in-Publication Data The ADA practical guide to substance use disorders and safe prescribing / edited by Michael O’Neil p ; cm Practical guide to substance use disorders and safe prescribing American... issuing body III Title: Practical guide to substance use disorders and safe prescribing IV Title: American Dental Association practical guide to substance use disorders and safe prescribing [DNLM:... alcoholics and to practice these principles in all our affairs www.pdflobby.com 22 The ADA Practical Guide to Substance Use Disorders and Safe Prescribing Table 2.4 Clinical Considerations Prior to Administering