Prescription opioids are the most commonly prescribed medication of any drug category in the United States, exceeding 200 million prescriptions annually. As prescriptions for opioid analgesics have increased significantly over the past two decades, so has the incidence of medication misuse, rates of abuse and dependence, overdoses, and unintentional fatalities. Prescription opioid misuse accounts for over $50 billion in public health expenditures each year and has been declared a national epidemic by the White House Office of National Drug Control Policy. Dental practitioners are the second leading prescriber - following primary care physicians - of prescription opioids. Dentists prescribe one out of every ten prescription opioids dispensed. Despite their significant role as prescribers of opioids for the management of acute dental pain, there is a dearth of empirical information available to guide intervention development for this group of frontline healthcare providers. Information regarding dental practitioners' knowledge, [motivations,] and prescribing practice behavior is necessary to inform the development, dissemination, and implementation of best practices and safe opioid prescribing interventions to curtail misuse and diversion. [The current K23 Mentored Patient- Oriented Research Career Development Award application will provide the required time, resources, and training necessary for the candidate to accomplish the proposed training and research goals under sound mentorship, and ultimately achieve the long-term goal of independence as a patient-oriented drug abuse researcher with the requisite skills and knowledge to disseminate and implement evidence-based interventions in frontline healthcare settings. In order to accomplish this long-term goal, the candidate will complete of a series of rigorous formal coursework, as well as receive hands-on state-of-the-science mentorship in addictions science (Primary Mentor: Kathleen T. Brady, MD, PhD), dissemination and implementation research (Cathy L. Melvin, PhD, MPH), and pain management - including clinical observation of dental clinic- based opioid prescribing (Roger B. Fillingim, PhD, Renata Leite, DDS). In tandem with the proposed training, the immediate aims of this research are to: (a) examine opioid prescribing knowledge and practices of dentists and identify viable targets for intervention, and (b) develop and conduct a pilot randomized controlled trial of a dental provider intervention to address identified critical gaps in provider knowledge, enhance provider motivation, and improve provider ability to identify prescription opioid misuse behaviors. The candidate will use findings from South Carolina Prescription Drug Monitoring Program data (Aim 1) and a statewide survey of dentists' opioid prescribing practices (Aim 2) to inform the development and evaluation of a brief, web-based, educational intervention (Aim 3). The intervention will target increased opioid misuse screening, use of existing prescription drug monitoring programs, and provision of patient-education among dental practitioners. A pilot randomized controlled trial, comparing the developed intervention with an attention control condition, will be conducted to demonstrate feasibility of methodology and assessments and generate the preliminary data necessary to support a subsequent R01 application to fund a full-scale evaluation of the intervention. The proposed projects will provide critical information regarding dental prescribing practices, including knowledge gaps and viable intervention targets. Further, this project will result in a fully developed and pilot tested provider-level intervention to help reduce misuse of opioid analgesics in dental practices. The training and mentorship received throughout the award period will ensure that the candidate has the necessary knowledge, demonstrated competencies, and critical preliminary data to support subsequent application for funding of a full-scale randomized controlled trial of the dental provider intervention, as well as establish the candidate as an independent investigator capable of promoting the dissemination and implementation of opioid risk mitigation strategies in dental practices across the nation.]

Public Health Relevance

Prescription opioid misuse is a serious public health issue, accounting for over $50 billion in annual public health expenditures. Dental providers are the second leading prescriber of opioids; however, the limited existing evidence suggests that most dentists are unaware of the risks of opioid misuse, abuse, and diversion among their patients, as well as how best to mitigate these risks. The current project will provide the candidate with training and mentorship necessary to: (1) use existing data from a statewide prescription drug monitoring database to examine patterns of opioid prescribing among dental practitioners, as well as the prevalence and patient characteristics associated with opioid misuse behaviors; (2) conduct a statewide survey of dental practitioners to evaluate knowledge regarding the scope of opioid diversion and abuse, current opioid prescribing practices, and current use and barriers to use of opioid risk mitigation strategies; and (3) develop and conduct a pilot randomized controlled trial of a brief, web-based, educational intervention targeting increased opioid misuse screening, use of existing prescription drug monitoring programs, and provision of patient-education among dental practitioners.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
5K23DA036566-04
Application #
9412819
Study Section
Special Emphasis Panel (ZRG1)
Program Officer
Thomas, David A
Project Start
2015-02-01
Project End
2020-01-31
Budget Start
2018-02-01
Budget End
2019-01-31
Support Year
4
Fiscal Year
2018
Total Cost
Indirect Cost
Name
Medical University of South Carolina
Department
Psychiatry
Type
Schools of Medicine
DUNS #
183710748
City
Charleston
State
SC
Country
United States
Zip Code
29403
Barth, Kelly S; Guille, Constance; McCauley, Jenna et al. (2017) Targeting practitioners: A review of guidelines, training, and policy in pain management. Drug Alcohol Depend 173 Suppl 1:S22-S30
Guille, Constance; Barth, Kelly S; Mateus, Julio et al. (2017) Treatment of Prescription Opioid Use Disorder in Pregnant Women. Am J Psychiatry 174:208-214
McCauley, Jenna L; Hyer, J Madison; Ramakrishnan, V Ramesh et al. (2016) Dental opioid prescribing and multiple opioid prescriptions among dental patients: Administrative data from the South Carolina prescription drug monitoring program. J Am Dent Assoc 147:537-44
McCauley, Jenna L; Leite, Renata S; Melvin, Cathy L et al. (2016) Dental opioid prescribing practices and risk mitigation strategy implementation: Identification of potential targets for provider-level intervention. Subst Abus 37:9-14
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Back, Sudie E; Gros, Daniel F; Price, Matthew et al. (2015) Laboratory-induced stress and craving among individuals with prescription opioid dependence. Drug Alcohol Depend 155:60-7
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