Dentist stresses prescriber education, shares personal story during Senate opioids hearing

Washington — As an oral surgeon and dental educator at the Virginia Commonwealth University School of Dentistry, Dr. A. Omar Abubaker was familiar with prescribing opioids to help patients manage their dental pain.

When his son, Adam, was given a prescription for 90 hydrocodone tablets following a shoulder injury, he didn't question the instructions for him to take a pill every "four to six hours" for pain. Four years later, Adam died from a mixture of heroin and benzodiazepines. He was 21. 

"Adam didn't choose heroin addiction," Dr. Abubaker told the Senate Health, Education, Labor and Pensions Committee on Nov. 30. 

Since his son's death in 2014, Dr. Abubaker has become an advocate for educating clinicians and students about safer prescribing methods. He's also become a champion for treating the root of the opioids problem: addiction. 

"Carrying my son's suffering and tragic death with me, I have been teaching at my university and traveling Virginia talking about the opioid epidemic, pain management and addiction to anybody who will listen," said Dr. Abubaker, who is chair of VCU's oral surgery department. "My goal is that each student and practitioner who leaves my class will be less inclined to prescribe excessive opioids, perhaps guarding one more son or daughter against the harm of narcotics." 

The Senate hearing, The Front Lines of the Opioid Crisis: Perspectives from States, Communities and Providers, was the second in a series of congressional hearings devoted to addressing the nation's ongoing opioid crisis.

"The toll of the opioid crisis that is ravaging our country is staggering," Committee Chair Lamar Alexander, R-Tenn., told a packed room in the Dirksen Senate building during his opening remarks. 

"The amount of opioids prescribed in the U.S. in 2015 was enough for every American to be medicated around the clock for three weeks, according to the Centers for Disease Control and Prevention," said Sen. Alexander, adding that every day 91 Americans die from an opioid overdose.

Dr. Abubaker wasn't the only one to share a personal story at the hearing. Sen. Johnny Isakson, R-Ga., revealed that in 2016 he lost his grandson to addiction. When Sen. Rand Paul, R-Ky., suffered six broken ribs in an assault earlier this month, the legislator and physician said he chose to treat his pain with ibuprofen instead of prescription narcotics. 

"Doctors don't want people to hurt," Sen. Paul said, "but we have made a mistake in overprescribing."

During his testimony, Dr. Abubaker focused on three things states can do to combat the epidemic — all of which he said are helping in his home state of Virginia:

• Limit the number of tablets prescribed for acute pain.
• Activate prescription monitoring programs.
• Increase naloxone training.

In March, the Virginia Board of Medicine adopted new guidelines, which included a recommendation that "treatment with opioids for acute pain must be with short-acting opioids, and for a seven-day supply or less." The state also require two hours of continuing medical education on opioid prescriptions for the renewal of medical and dental licenses. 

Said Sen. Al Franken, D-Minn., "I firmly believe all clinicians need this training." 

In 2015, Congress passed the 21st Century Cures Act, which appropriated $1 billion over two years for state grants to combat the epidemic, which the CDC says accounts for more than 33,000 deaths each year. The Comprehensive Addiction and Recovery Act led to the creation of new programs to address the crisis, but the need for funding remains a critical issue.

"If this were any other kind of public health crisis, we would be devoting considerably more resources," Sen. Maggie Hassan, D-N.H., said. "The stigma of addiction is why we're not. We need a long-term strategy."

Dr. Abubaker was one of four invited speakers at the Nov. 30 hearing. The committee also heard testimonies from Rebecca Boss, director of the Rhode Island Department of Behavioral Healthcare; Andrea Magermans, managing director of the Wisconsin Prescription Drug Monitoring Program; and John C. Tilley, secretary of the Kentucky Justice and Public Safety Cabinet.

When Sen. Hassan asked each of the speakers if their programs would benefit from additional funding, they all replied without hesitation, "Yes."

In 2016, the ADA updated its policy for managing dental pain, especially for patients who are at risk for drug overdose and/or addiction and encouraging dentists to consider using non-narcotic medications as a first-line pain therapy. 

The ADA also has offered free online continuing education on safe and effective opioid prescribing since 2012. The Association also developed "The ADA Practical Guide to Substance Use Disorders and Safe Prescribing." The clinical reference manual includes techniques dentists can use to manage pain for patients who may be at risk for substance dependence. 

Following the hearing, ADA President Joseph P. Crowley emailed House and Senate staff to personally share a copy of Dr. Abubaker's testimony. He reminded them that dentists' training, expertise and dedication to the public's health extends "well beyond the mouth."

"Dentists have been fighting the opioid abuse epidemic on all fronts," Dr. Crowley wrote. "We have developed new clinical guidelines, raised professional awareness, offered free continuing education, supported research into non-narcotic pain therapies, and more. We also know that there's more to do." 

Read Dr. Abubaker's written testimony here. Watch the full Senate hearing here.

Follow all of the ADA's advocacy efforts on opioids at ADA.org/opioids.