The ADA Practical Guide to Substance Use Disorders and Safe Prescribing (eBook, ePUB)
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The ADA Practical Guide to Substance Use Disorders and Safe Prescribing (eBook, ePUB)
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Dentists have been inundated by patients with an array of complicated medical conditions and pain/sedation management issues. This is in addition to a variety of legal regulations dentists must follow regarding the storage and recordkeeping of controlled substances. Avoid unknowingly putting your practice at risk by becoming victim to a scam or violating a recordkeeping requirement with The ADA Practical Guide to Substance Use Disorders and Safe Prescribing. This Practical Guide is ideal for dentists and staff as they navigate: * Detecting and deterring substance use disorders (SUD) and drug…mehr
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Dentists have been inundated by patients with an array of complicated medical conditions and pain/sedation management issues. This is in addition to a variety of legal regulations dentists must follow regarding the storage and recordkeeping of controlled substances. Avoid unknowingly putting your practice at risk by becoming victim to a scam or violating a recordkeeping requirement with The ADA Practical Guide to Substance Use Disorders and Safe Prescribing. This Practical Guide is ideal for dentists and staff as they navigate: * Detecting and deterring substance use disorders (SUD) and drug diversion in the dental office (drug-seeking patients) * Prescribing complexities * Treating patients with SUD and complex analgesic and sedation (pain/sedation management) needs and the best use of sedation anxiety medication * Interviewing and counselling options for SUD * Federal drug regulations Commonly used illicit, prescription, and over-the-counter drugs, as well as alcohol and tobacco, are also covered. Special features include: * Clinical tools proven to aid in the identification, interviewing, intervention, referral and treatment of SUD * Basic elements of SUD, acute pain/sedation management, and drug diversion * Summary of evidence-based literature that supports what, when and how to prescribe controlled substances to patients with SUD * Discussion of key federal controlled substance regulations that frequently impact dental practitioners * Checklists to help prevent drug diversion in dental practices * Chapter on impaired dental professionals * Case studies that examine safe prescribing and due diligence
Produktdetails
- Produktdetails
- Verlag: John Wiley & Sons
- Seitenzahl: 240
- Erscheinungstermin: 6. Mai 2015
- Englisch
- ISBN-13: 9781118925270
- Artikelnr.: 42833294
- Verlag: John Wiley & Sons
- Seitenzahl: 240
- Erscheinungstermin: 6. Mai 2015
- Englisch
- ISBN-13: 9781118925270
- Artikelnr.: 42833294
Michael O'Neil, Pharm.D., is Professor and Vice Chair of the Department of Pharmacy Practice at South College School of Pharmacy in Knoxville, Tennessee. Dr. O'Neil has more than 25 years' experience as a critical care and pain specialist and has taught pharmacy students, pharmacy residents, nursing students, surgery/medical students, and medical residents in the classroom and at the bedside. He has completed research and published in several leading health professional journals including pharmacy, dentistry, and nursing. Dr. O'Neil has also served as a consultant and expert on prescription drug abuse, substance abuse, and drug diversion for the U.S. Drug Enforcement Agency, the Bureau of Criminal Investigation, the U.S. Attorney's Office, the West Virginia Board of Dental Examiners, the American Association of Dental Boards, and several law enforcement agencies. Dr. O'Neil developed the West Virginia Pharmacists Recovery Network where he served as Executive Director and head investigator. Dr. O'Neil helped initiate other professional recovery networks in medicine, dentistry and nursing.
Contributors xxx Preface xxx Acknowledgements xxx 1. Substance Use Disorders, Drug Diversion and Pain Management- The Scope of the Problem Michael O'Neil 1. Introduction 2. Definitions 3. Overview: SUD, Drug Misuse, Drug diversion and Pain Management a. SUD b. Medication Misuse c. Alcoholism d. Drug Diversion e. Pain Management in Dentistry 4. Understanding the Cultures of SUD, Drug Misuse and Drug Diversion a. Sharing Culture b. Income Driven Culture c. Substance Abuse Culture d. Addiction Culture e. Combination of Cultures 5. Summary 2. Understanding the Disease of Substance Use Disorder Carl Rollynn Sullivan and James Berry 1. Introduction 2. Definitions 3. Epidemiology: Drug / Alcohol 4. Pathophysiology 5. Signs /Symptoms/ Behavior a. alcohol b. benzodiazepines c. opioids d. stimulants e. cannabis f. nicotine g. hallucinogens, designer drugs, inhalants 6. Treatment methods a. Behavior modification and counseling 1. Motivational Interviewing 2. CBT 3. Contingency Management 4. AA / 12 steps b. Pharmacological management (Agents, pharmacology, pharmacokinetics, dosing, adverse effects, contraindications, drug selection, goals, duration of treatment, monitoring, outcome documentation) 7. Summary 3. Principles of Pain Management in Dentistry Paul Moore and Elliot Hersh 1. Introduction 2. Definitions 3. Neurophysiology and Neuroanatomy of Acute Inflammatory Pain 4. Agents, pharmacology, pharmacokinetics, dosing, adverse effects, contraindications, Drug selection, duration of treatment, monitoring, documentation a. nonopioid b. opioid 5. Medication Assisted Therapies for Drug Dependence 6. Adjunctive Drugs 7. Preemptive Analgesics 8. Corticosteroids 9. Guidelines to Analgesic Therapy 10. Summary 5. Special populations (renal insufficiency, coagulopathies, etc.) 6. Safe prescribing considerations 7. Summary 4. Special Pain Management Considerations Michael O'Neil 1. Introduction 2. Definitions 3. Interviewing the Patient: Establishing Goals of Treatment 4. Pharmacological Treatment of Opioid Addiction / Acute Pain a. methadone b. buprenorphine c. naltrexone 5. Acute pain management patients with chronic nonmalignant pain 6. Summary 5. Sedation and Anxiolysis Matthew Cooke 1. Introduction 2. Definitions 3. Spectrum of Anesthesia and Sedation 4. Preoperative evaluation 5. Physical Status Classification 6. Sedation 7. Medications in Patients with SUD a. nitrous oxide b. benzodiazepines c. opioids d. ketamine e. propofol f. alpha-agonist g. local anesthetics 8. Balance Anesthesia 9. Monitoring and documentation 10. Moderate conscious sedation 11. Deep sedation 12. Emergencies 13. Special considerations 14. Summary 6. Common Substances and Medications of Abuse George Raymond and William Maloney 1. Introduction 2. Definitions 3. Signs and symptoms 4. (drugs/chemicals, pharmacology, effects, routes, dental characteristics/patho, disease specific complications) a. Illicit drugs 1. Stimulants - Methamphetamine, Cocaine 2. Hallucinogens 3. Opioids 4. Inhalants 5. CNS depressants 6. Marijuana 5. Prescription Drugs 1. Opioids 2. Stimulants 3. CNS depressants 4. Antipsychotics 5. Muscle relaxants 6. Anticonvulsants 7. Other Agents 6. OTCs 7. Summary 7. Nicotine and tobacco Cessation Frank Vitale and Amanda Eades 1. Introduction 2. Definitions 3. Epidemiology -cigarettes, cigars, pipes, water pipes, chewing tobacco, dip/snuff 4. Oral effects of tobacco 5. Dental practitioner Management of Tobacco USE a. Brief intervention b. Low intensity c. Moderate intensity d. Spit tobacco interventions 6. Medication Management a. Role of nicotine b. NRT c. Individual Agents d. Non FDA approved treatments 7. Summary 8. Detection and Deterrence of Substance Use Disorder and Drug Diversion in Dental Practice Sarah Melton and Ralph Orr 1. Introduction 2. Definitions 3. Screening patients and referrals for treatment/intervention a. SBIRT b. CAGE c. NMASSIST 4. Schemes and scams a. In office behaviors b. Behavior prevention c. Out of office behaviors d. Dental practitioner Diversion 5. PDMP a. Brief History of PDMPs b. PDMP as a tool / general principles c. Interpreting PDMP reports d. Case 6. Drug disposal 7. Universal Safe prescribing practices 9. Summary 9. Dentist Interviewing and Counseling of Patients with Substance Use Disorders and Dealing with Drug Seeking Patients George Raymond and William Maloney 1. Introduction 2. Definitions 3. Pre-interview considerations 4. Questions to ask 5. Interviewing / counseling 6. Screening tools 7. Documentation 8. Summary 10. Office Management of Controlled Substances and Record Keeping Carlos Aquino 1. Introduction 2. Definitions 3. Federal and State Regulations 4. Common violations by dentist a. Scope of practice b. Record keeping c. Storage d. Record keeping 5. Record Keeping a. Purchasing / storage /security b. Drug disposal 6. Documentation 7. Surviving a Dental Board Inspection or DEA Audit 8. Due Diligence 9. Non-Controlled Substance Management 10. Summary 11. The Impaired Dental Health Professional and Office Staff William Kane 1. Introduction 2. Definitions 3. Epidemiology of Substance Use Disorder in healthcare 4. Neurobiology 5. Stigma of Addiction 6. Risk Factors 7. Substances of Choice 8. Identification of the Impaired Professional 9. Interventions 10. Treatment 11. Well-being Committees 12. Summary 12. Due Diligence and Safe Prescribing Michael O'Neil 1. Introduction 2. Definitions 3. Case Scenarios A-J 4. Summary Continuing Education Questions, xxx Index xxx
Contributors xi Preface xiii Acknowledgments xv 1 Substance Use Disorders,
Drug Diversion, and Pain Management: The Scope of the Problem 1 Michael
O'Neil, PharmD Introduction 1 Definitions 2 Substance Use Disorder, Drug
Misuse, Drug Diversion, and Pain Management in the Dental Community 4
Understanding the Cultures of Substance Use Disorder, Drug Misuse, and Drug
Diversion 8 Summary 9 References 10 2 Understanding the Disease of
Substance Use Disorders 11 James H. Berry, DO and Carl Rollynn Sullivan, MD
Introduction 11 Definitions 11 Epidemiology: Drug/Alcohol 13
Pathophysiology/Brain Pathways 14 Signs, Symptoms, Behavior 15 Treatment
Methods 20 Summary 26 Appendix 2.A: Common Opioid Analgesics and their
Brand Names 27 References 29 Resources and Further Readings 30 3 Principles
of Pain Management in Dentistry 31 Paul A. Moore, DMD, PhD, MPH and Elliot
V. Hersh, DMD, MS, PhD Introduction 31 Definitions 32 Neurophysiology and
Neuroanatomy of Acute Inflammatory Pain 32 Orally Administered Analgesic
Agents 33 Medication-Assisted Therapies for Treating Drug-Dependent
Patients 41 Adjunctive Drugs Used to Limit Pain in Dentistry 41 Guidelines
for Analgesic Therapy 43 Summary 45 References 45 Resources and Further
Readings 46 4 Special Pain Management Considerations: (1) Chronic
Methadone, Buprenorphine, and Naltrexone Therapy; (2) Chronic Opioids for
Nonmalignant Pain 47 Michael O'Neil, PharmD Introduction 47 Definitions 48
Interviewing the Patient: Establishing Goals of Treatment 49
Pharmacological Treatment of Opioid Addiction 49 Treating Acute Dental Pain
51 Acute Pain in Patients Receiving Opioid Maintenance Therapy 51 The
Active Opioid Addict 55 Acute Pain Management in Patients Receiving
Naltrexone Therapy 56 Acute Pain Management in Patients Receiving Opioids
for Chronic Pain 57 Summary 57 References 58 5 Sedation and Anxiolysis 61
Matthew Cooke, DDS, MD, MPH Introduction 61 Definitions 61 Spectrum of
Anesthesia and Sedation 62 Preoperative Evaluation 64 Physical Status
Classification 65 Sedation 65 Medications Available for Sedation of
Patients with Substance Use Disorder 68 The Concept of Balanced Anesthesia
76 Monitoring and Documentation 76 Summary 78 Disclaimer 78 References 79
Resources and Further Readings 82 6 Common Substances and Medications of
Abuse 83 William J. Maloney, DDS and George F. Raymond, DDS Introduction 83
Definitions 83 Signs and Symptoms of Substance Use Disorder 85 Common
Substances of Abuse 86 Prescription Medications 100 Over-the-Counter
Medications 111 Summary 112 References 112 Resources and Further Readings
118 7 Tobacco Cessation: Behavioral and Pharmacological Considerations 119
Frank Vitale, MA and Amanda Eades, PharmD Introduction 119 Definitions 119
Forms of Tobacco 121 Oral Effects of Tobacco Use 121 Dental Practitioner
Management of Tobacco Use 122 Spit Tobacco Interventions 124 Oral
Substitutes 125 Social Support/Disapproval 125 Medication Management for
Smoking Cessation 126 The Role of Nicotine 126 Pharmacotherapy Options 127
Summary 138 References 138 Resources and Further Readings 140 8 Detection
and Deterrence of Substance Use Disorders and Drug Diversion in Dental
Practice 141 Sarah T. Melton, PharmD, BCPP, BCACP, CGP, FASCP and Ralph A.
Orr Introduction 141 Definitions 141 Screening Patients for Substance Use
Disorder 142 Schemes and Scams to Obtain Prescription Drugs 144 Dental
Practitioner- and Office Personnel-Related Prescription Drug Diversion 147
Prescription Drug Monitoring Programs 148 Disposal of Controlled Substances
153 Universal Precautions in Prescribing Controlled Substances 154 Summary
157 References 157 Resources and Further Readings 158 9 Interviewing and
Counseling Patients with Known or Suspected Substance Use Disorders:
Dealing with Drug-seeking Patients 159 George F. Raymond, DDS and William
J. Maloney, DDS Introduction 159 Definitions 160 Preinterview
Considerations 160 Patient Interview Considerations 161 Interviewing and
Counseling Techniques 162 What Questions Should Be Asked? 163 Screening
Tools 164 Documentation 165 Summary 166 References 166 Resources and
Further Readings 167 10 Office Management of Controlled Substances 169
Carlos M. Aquino Introduction 169 Federal Statutes and Regulations 169
Definitions 169 Common Violations by Dental Practitioners 170 Surviving a
Drug Enforcement Administration Inspection 173 Practice Due Diligence
Program 175 Management of Noncontrolled Substances in the Office 176
Summary 176 Resources and Further Readings 176 11 Addiction and Impairment
in the Dental Professional 177 William T. Kane, DDS, MBA, FAGD, FACD
Introduction 177 Definitions 178 The Complexity of Addiction 178 The
Neurobiology of Addiction 179 The Stigma of Addiction 180 Epidemiology of
Addiction in Dentistry 180 Risk Factors for Substance Use Disorder 180
Substances of Choice 182 Identifying Addiction 183 "The Conspiracy of
Silence" 183 Intervention 184 Evaluation/Assessment 185 Treatment 186
Family and Staff 186 Relapse 187 Monitoring 187 Peer Assistance or Dental
Well-being Committee Programs 187 Summary 189 References 189 Resources and
Further Readings 190 12 Due Diligence and Safe Prescribing 191 Michael
O'Neil, PharmD Introduction 191 Definitions 191 Case Scenarios 192 Summary
205 References 206 Continuing Education Examination 207 Index 213
Drug Diversion, and Pain Management: The Scope of the Problem 1 Michael
O'Neil, PharmD Introduction 1 Definitions 2 Substance Use Disorder, Drug
Misuse, Drug Diversion, and Pain Management in the Dental Community 4
Understanding the Cultures of Substance Use Disorder, Drug Misuse, and Drug
Diversion 8 Summary 9 References 10 2 Understanding the Disease of
Substance Use Disorders 11 James H. Berry, DO and Carl Rollynn Sullivan, MD
Introduction 11 Definitions 11 Epidemiology: Drug/Alcohol 13
Pathophysiology/Brain Pathways 14 Signs, Symptoms, Behavior 15 Treatment
Methods 20 Summary 26 Appendix 2.A: Common Opioid Analgesics and their
Brand Names 27 References 29 Resources and Further Readings 30 3 Principles
of Pain Management in Dentistry 31 Paul A. Moore, DMD, PhD, MPH and Elliot
V. Hersh, DMD, MS, PhD Introduction 31 Definitions 32 Neurophysiology and
Neuroanatomy of Acute Inflammatory Pain 32 Orally Administered Analgesic
Agents 33 Medication-Assisted Therapies for Treating Drug-Dependent
Patients 41 Adjunctive Drugs Used to Limit Pain in Dentistry 41 Guidelines
for Analgesic Therapy 43 Summary 45 References 45 Resources and Further
Readings 46 4 Special Pain Management Considerations: (1) Chronic
Methadone, Buprenorphine, and Naltrexone Therapy; (2) Chronic Opioids for
Nonmalignant Pain 47 Michael O'Neil, PharmD Introduction 47 Definitions 48
Interviewing the Patient: Establishing Goals of Treatment 49
Pharmacological Treatment of Opioid Addiction 49 Treating Acute Dental Pain
51 Acute Pain in Patients Receiving Opioid Maintenance Therapy 51 The
Active Opioid Addict 55 Acute Pain Management in Patients Receiving
Naltrexone Therapy 56 Acute Pain Management in Patients Receiving Opioids
for Chronic Pain 57 Summary 57 References 58 5 Sedation and Anxiolysis 61
Matthew Cooke, DDS, MD, MPH Introduction 61 Definitions 61 Spectrum of
Anesthesia and Sedation 62 Preoperative Evaluation 64 Physical Status
Classification 65 Sedation 65 Medications Available for Sedation of
Patients with Substance Use Disorder 68 The Concept of Balanced Anesthesia
76 Monitoring and Documentation 76 Summary 78 Disclaimer 78 References 79
Resources and Further Readings 82 6 Common Substances and Medications of
Abuse 83 William J. Maloney, DDS and George F. Raymond, DDS Introduction 83
Definitions 83 Signs and Symptoms of Substance Use Disorder 85 Common
Substances of Abuse 86 Prescription Medications 100 Over-the-Counter
Medications 111 Summary 112 References 112 Resources and Further Readings
118 7 Tobacco Cessation: Behavioral and Pharmacological Considerations 119
Frank Vitale, MA and Amanda Eades, PharmD Introduction 119 Definitions 119
Forms of Tobacco 121 Oral Effects of Tobacco Use 121 Dental Practitioner
Management of Tobacco Use 122 Spit Tobacco Interventions 124 Oral
Substitutes 125 Social Support/Disapproval 125 Medication Management for
Smoking Cessation 126 The Role of Nicotine 126 Pharmacotherapy Options 127
Summary 138 References 138 Resources and Further Readings 140 8 Detection
and Deterrence of Substance Use Disorders and Drug Diversion in Dental
Practice 141 Sarah T. Melton, PharmD, BCPP, BCACP, CGP, FASCP and Ralph A.
Orr Introduction 141 Definitions 141 Screening Patients for Substance Use
Disorder 142 Schemes and Scams to Obtain Prescription Drugs 144 Dental
Practitioner- and Office Personnel-Related Prescription Drug Diversion 147
Prescription Drug Monitoring Programs 148 Disposal of Controlled Substances
153 Universal Precautions in Prescribing Controlled Substances 154 Summary
157 References 157 Resources and Further Readings 158 9 Interviewing and
Counseling Patients with Known or Suspected Substance Use Disorders:
Dealing with Drug-seeking Patients 159 George F. Raymond, DDS and William
J. Maloney, DDS Introduction 159 Definitions 160 Preinterview
Considerations 160 Patient Interview Considerations 161 Interviewing and
Counseling Techniques 162 What Questions Should Be Asked? 163 Screening
Tools 164 Documentation 165 Summary 166 References 166 Resources and
Further Readings 167 10 Office Management of Controlled Substances 169
Carlos M. Aquino Introduction 169 Federal Statutes and Regulations 169
Definitions 169 Common Violations by Dental Practitioners 170 Surviving a
Drug Enforcement Administration Inspection 173 Practice Due Diligence
Program 175 Management of Noncontrolled Substances in the Office 176
Summary 176 Resources and Further Readings 176 11 Addiction and Impairment
in the Dental Professional 177 William T. Kane, DDS, MBA, FAGD, FACD
Introduction 177 Definitions 178 The Complexity of Addiction 178 The
Neurobiology of Addiction 179 The Stigma of Addiction 180 Epidemiology of
Addiction in Dentistry 180 Risk Factors for Substance Use Disorder 180
Substances of Choice 182 Identifying Addiction 183 "The Conspiracy of
Silence" 183 Intervention 184 Evaluation/Assessment 185 Treatment 186
Family and Staff 186 Relapse 187 Monitoring 187 Peer Assistance or Dental
Well-being Committee Programs 187 Summary 189 References 189 Resources and
Further Readings 190 12 Due Diligence and Safe Prescribing 191 Michael
O'Neil, PharmD Introduction 191 Definitions 191 Case Scenarios 192 Summary
205 References 206 Continuing Education Examination 207 Index 213
Contributors xxx Preface xxx Acknowledgements xxx 1. Substance Use Disorders, Drug Diversion and Pain Management- The Scope of the Problem Michael O'Neil 1. Introduction 2. Definitions 3. Overview: SUD, Drug Misuse, Drug diversion and Pain Management a. SUD b. Medication Misuse c. Alcoholism d. Drug Diversion e. Pain Management in Dentistry 4. Understanding the Cultures of SUD, Drug Misuse and Drug Diversion a. Sharing Culture b. Income Driven Culture c. Substance Abuse Culture d. Addiction Culture e. Combination of Cultures 5. Summary 2. Understanding the Disease of Substance Use Disorder Carl Rollynn Sullivan and James Berry 1. Introduction 2. Definitions 3. Epidemiology: Drug / Alcohol 4. Pathophysiology 5. Signs /Symptoms/ Behavior a. alcohol b. benzodiazepines c. opioids d. stimulants e. cannabis f. nicotine g. hallucinogens, designer drugs, inhalants 6. Treatment methods a. Behavior modification and counseling 1. Motivational Interviewing 2. CBT 3. Contingency Management 4. AA / 12 steps b. Pharmacological management (Agents, pharmacology, pharmacokinetics, dosing, adverse effects, contraindications, drug selection, goals, duration of treatment, monitoring, outcome documentation) 7. Summary 3. Principles of Pain Management in Dentistry Paul Moore and Elliot Hersh 1. Introduction 2. Definitions 3. Neurophysiology and Neuroanatomy of Acute Inflammatory Pain 4. Agents, pharmacology, pharmacokinetics, dosing, adverse effects, contraindications, Drug selection, duration of treatment, monitoring, documentation a. nonopioid b. opioid 5. Medication Assisted Therapies for Drug Dependence 6. Adjunctive Drugs 7. Preemptive Analgesics 8. Corticosteroids 9. Guidelines to Analgesic Therapy 10. Summary 5. Special populations (renal insufficiency, coagulopathies, etc.) 6. Safe prescribing considerations 7. Summary 4. Special Pain Management Considerations Michael O'Neil 1. Introduction 2. Definitions 3. Interviewing the Patient: Establishing Goals of Treatment 4. Pharmacological Treatment of Opioid Addiction / Acute Pain a. methadone b. buprenorphine c. naltrexone 5. Acute pain management patients with chronic nonmalignant pain 6. Summary 5. Sedation and Anxiolysis Matthew Cooke 1. Introduction 2. Definitions 3. Spectrum of Anesthesia and Sedation 4. Preoperative evaluation 5. Physical Status Classification 6. Sedation 7. Medications in Patients with SUD a. nitrous oxide b. benzodiazepines c. opioids d. ketamine e. propofol f. alpha-agonist g. local anesthetics 8. Balance Anesthesia 9. Monitoring and documentation 10. Moderate conscious sedation 11. Deep sedation 12. Emergencies 13. Special considerations 14. Summary 6. Common Substances and Medications of Abuse George Raymond and William Maloney 1. Introduction 2. Definitions 3. Signs and symptoms 4. (drugs/chemicals, pharmacology, effects, routes, dental characteristics/patho, disease specific complications) a. Illicit drugs 1. Stimulants - Methamphetamine, Cocaine 2. Hallucinogens 3. Opioids 4. Inhalants 5. CNS depressants 6. Marijuana 5. Prescription Drugs 1. Opioids 2. Stimulants 3. CNS depressants 4. Antipsychotics 5. Muscle relaxants 6. Anticonvulsants 7. Other Agents 6. OTCs 7. Summary 7. Nicotine and tobacco Cessation Frank Vitale and Amanda Eades 1. Introduction 2. Definitions 3. Epidemiology -cigarettes, cigars, pipes, water pipes, chewing tobacco, dip/snuff 4. Oral effects of tobacco 5. Dental practitioner Management of Tobacco USE a. Brief intervention b. Low intensity c. Moderate intensity d. Spit tobacco interventions 6. Medication Management a. Role of nicotine b. NRT c. Individual Agents d. Non FDA approved treatments 7. Summary 8. Detection and Deterrence of Substance Use Disorder and Drug Diversion in Dental Practice Sarah Melton and Ralph Orr 1. Introduction 2. Definitions 3. Screening patients and referrals for treatment/intervention a. SBIRT b. CAGE c. NMASSIST 4. Schemes and scams a. In office behaviors b. Behavior prevention c. Out of office behaviors d. Dental practitioner Diversion 5. PDMP a. Brief History of PDMPs b. PDMP as a tool / general principles c. Interpreting PDMP reports d. Case 6. Drug disposal 7. Universal Safe prescribing practices 9. Summary 9. Dentist Interviewing and Counseling of Patients with Substance Use Disorders and Dealing with Drug Seeking Patients George Raymond and William Maloney 1. Introduction 2. Definitions 3. Pre-interview considerations 4. Questions to ask 5. Interviewing / counseling 6. Screening tools 7. Documentation 8. Summary 10. Office Management of Controlled Substances and Record Keeping Carlos Aquino 1. Introduction 2. Definitions 3. Federal and State Regulations 4. Common violations by dentist a. Scope of practice b. Record keeping c. Storage d. Record keeping 5. Record Keeping a. Purchasing / storage /security b. Drug disposal 6. Documentation 7. Surviving a Dental Board Inspection or DEA Audit 8. Due Diligence 9. Non-Controlled Substance Management 10. Summary 11. The Impaired Dental Health Professional and Office Staff William Kane 1. Introduction 2. Definitions 3. Epidemiology of Substance Use Disorder in healthcare 4. Neurobiology 5. Stigma of Addiction 6. Risk Factors 7. Substances of Choice 8. Identification of the Impaired Professional 9. Interventions 10. Treatment 11. Well-being Committees 12. Summary 12. Due Diligence and Safe Prescribing Michael O'Neil 1. Introduction 2. Definitions 3. Case Scenarios A-J 4. Summary Continuing Education Questions, xxx Index xxx
Contributors xi Preface xiii Acknowledgments xv 1 Substance Use Disorders,
Drug Diversion, and Pain Management: The Scope of the Problem 1 Michael
O'Neil, PharmD Introduction 1 Definitions 2 Substance Use Disorder, Drug
Misuse, Drug Diversion, and Pain Management in the Dental Community 4
Understanding the Cultures of Substance Use Disorder, Drug Misuse, and Drug
Diversion 8 Summary 9 References 10 2 Understanding the Disease of
Substance Use Disorders 11 James H. Berry, DO and Carl Rollynn Sullivan, MD
Introduction 11 Definitions 11 Epidemiology: Drug/Alcohol 13
Pathophysiology/Brain Pathways 14 Signs, Symptoms, Behavior 15 Treatment
Methods 20 Summary 26 Appendix 2.A: Common Opioid Analgesics and their
Brand Names 27 References 29 Resources and Further Readings 30 3 Principles
of Pain Management in Dentistry 31 Paul A. Moore, DMD, PhD, MPH and Elliot
V. Hersh, DMD, MS, PhD Introduction 31 Definitions 32 Neurophysiology and
Neuroanatomy of Acute Inflammatory Pain 32 Orally Administered Analgesic
Agents 33 Medication-Assisted Therapies for Treating Drug-Dependent
Patients 41 Adjunctive Drugs Used to Limit Pain in Dentistry 41 Guidelines
for Analgesic Therapy 43 Summary 45 References 45 Resources and Further
Readings 46 4 Special Pain Management Considerations: (1) Chronic
Methadone, Buprenorphine, and Naltrexone Therapy; (2) Chronic Opioids for
Nonmalignant Pain 47 Michael O'Neil, PharmD Introduction 47 Definitions 48
Interviewing the Patient: Establishing Goals of Treatment 49
Pharmacological Treatment of Opioid Addiction 49 Treating Acute Dental Pain
51 Acute Pain in Patients Receiving Opioid Maintenance Therapy 51 The
Active Opioid Addict 55 Acute Pain Management in Patients Receiving
Naltrexone Therapy 56 Acute Pain Management in Patients Receiving Opioids
for Chronic Pain 57 Summary 57 References 58 5 Sedation and Anxiolysis 61
Matthew Cooke, DDS, MD, MPH Introduction 61 Definitions 61 Spectrum of
Anesthesia and Sedation 62 Preoperative Evaluation 64 Physical Status
Classification 65 Sedation 65 Medications Available for Sedation of
Patients with Substance Use Disorder 68 The Concept of Balanced Anesthesia
76 Monitoring and Documentation 76 Summary 78 Disclaimer 78 References 79
Resources and Further Readings 82 6 Common Substances and Medications of
Abuse 83 William J. Maloney, DDS and George F. Raymond, DDS Introduction 83
Definitions 83 Signs and Symptoms of Substance Use Disorder 85 Common
Substances of Abuse 86 Prescription Medications 100 Over-the-Counter
Medications 111 Summary 112 References 112 Resources and Further Readings
118 7 Tobacco Cessation: Behavioral and Pharmacological Considerations 119
Frank Vitale, MA and Amanda Eades, PharmD Introduction 119 Definitions 119
Forms of Tobacco 121 Oral Effects of Tobacco Use 121 Dental Practitioner
Management of Tobacco Use 122 Spit Tobacco Interventions 124 Oral
Substitutes 125 Social Support/Disapproval 125 Medication Management for
Smoking Cessation 126 The Role of Nicotine 126 Pharmacotherapy Options 127
Summary 138 References 138 Resources and Further Readings 140 8 Detection
and Deterrence of Substance Use Disorders and Drug Diversion in Dental
Practice 141 Sarah T. Melton, PharmD, BCPP, BCACP, CGP, FASCP and Ralph A.
Orr Introduction 141 Definitions 141 Screening Patients for Substance Use
Disorder 142 Schemes and Scams to Obtain Prescription Drugs 144 Dental
Practitioner- and Office Personnel-Related Prescription Drug Diversion 147
Prescription Drug Monitoring Programs 148 Disposal of Controlled Substances
153 Universal Precautions in Prescribing Controlled Substances 154 Summary
157 References 157 Resources and Further Readings 158 9 Interviewing and
Counseling Patients with Known or Suspected Substance Use Disorders:
Dealing with Drug-seeking Patients 159 George F. Raymond, DDS and William
J. Maloney, DDS Introduction 159 Definitions 160 Preinterview
Considerations 160 Patient Interview Considerations 161 Interviewing and
Counseling Techniques 162 What Questions Should Be Asked? 163 Screening
Tools 164 Documentation 165 Summary 166 References 166 Resources and
Further Readings 167 10 Office Management of Controlled Substances 169
Carlos M. Aquino Introduction 169 Federal Statutes and Regulations 169
Definitions 169 Common Violations by Dental Practitioners 170 Surviving a
Drug Enforcement Administration Inspection 173 Practice Due Diligence
Program 175 Management of Noncontrolled Substances in the Office 176
Summary 176 Resources and Further Readings 176 11 Addiction and Impairment
in the Dental Professional 177 William T. Kane, DDS, MBA, FAGD, FACD
Introduction 177 Definitions 178 The Complexity of Addiction 178 The
Neurobiology of Addiction 179 The Stigma of Addiction 180 Epidemiology of
Addiction in Dentistry 180 Risk Factors for Substance Use Disorder 180
Substances of Choice 182 Identifying Addiction 183 "The Conspiracy of
Silence" 183 Intervention 184 Evaluation/Assessment 185 Treatment 186
Family and Staff 186 Relapse 187 Monitoring 187 Peer Assistance or Dental
Well-being Committee Programs 187 Summary 189 References 189 Resources and
Further Readings 190 12 Due Diligence and Safe Prescribing 191 Michael
O'Neil, PharmD Introduction 191 Definitions 191 Case Scenarios 192 Summary
205 References 206 Continuing Education Examination 207 Index 213
Drug Diversion, and Pain Management: The Scope of the Problem 1 Michael
O'Neil, PharmD Introduction 1 Definitions 2 Substance Use Disorder, Drug
Misuse, Drug Diversion, and Pain Management in the Dental Community 4
Understanding the Cultures of Substance Use Disorder, Drug Misuse, and Drug
Diversion 8 Summary 9 References 10 2 Understanding the Disease of
Substance Use Disorders 11 James H. Berry, DO and Carl Rollynn Sullivan, MD
Introduction 11 Definitions 11 Epidemiology: Drug/Alcohol 13
Pathophysiology/Brain Pathways 14 Signs, Symptoms, Behavior 15 Treatment
Methods 20 Summary 26 Appendix 2.A: Common Opioid Analgesics and their
Brand Names 27 References 29 Resources and Further Readings 30 3 Principles
of Pain Management in Dentistry 31 Paul A. Moore, DMD, PhD, MPH and Elliot
V. Hersh, DMD, MS, PhD Introduction 31 Definitions 32 Neurophysiology and
Neuroanatomy of Acute Inflammatory Pain 32 Orally Administered Analgesic
Agents 33 Medication-Assisted Therapies for Treating Drug-Dependent
Patients 41 Adjunctive Drugs Used to Limit Pain in Dentistry 41 Guidelines
for Analgesic Therapy 43 Summary 45 References 45 Resources and Further
Readings 46 4 Special Pain Management Considerations: (1) Chronic
Methadone, Buprenorphine, and Naltrexone Therapy; (2) Chronic Opioids for
Nonmalignant Pain 47 Michael O'Neil, PharmD Introduction 47 Definitions 48
Interviewing the Patient: Establishing Goals of Treatment 49
Pharmacological Treatment of Opioid Addiction 49 Treating Acute Dental Pain
51 Acute Pain in Patients Receiving Opioid Maintenance Therapy 51 The
Active Opioid Addict 55 Acute Pain Management in Patients Receiving
Naltrexone Therapy 56 Acute Pain Management in Patients Receiving Opioids
for Chronic Pain 57 Summary 57 References 58 5 Sedation and Anxiolysis 61
Matthew Cooke, DDS, MD, MPH Introduction 61 Definitions 61 Spectrum of
Anesthesia and Sedation 62 Preoperative Evaluation 64 Physical Status
Classification 65 Sedation 65 Medications Available for Sedation of
Patients with Substance Use Disorder 68 The Concept of Balanced Anesthesia
76 Monitoring and Documentation 76 Summary 78 Disclaimer 78 References 79
Resources and Further Readings 82 6 Common Substances and Medications of
Abuse 83 William J. Maloney, DDS and George F. Raymond, DDS Introduction 83
Definitions 83 Signs and Symptoms of Substance Use Disorder 85 Common
Substances of Abuse 86 Prescription Medications 100 Over-the-Counter
Medications 111 Summary 112 References 112 Resources and Further Readings
118 7 Tobacco Cessation: Behavioral and Pharmacological Considerations 119
Frank Vitale, MA and Amanda Eades, PharmD Introduction 119 Definitions 119
Forms of Tobacco 121 Oral Effects of Tobacco Use 121 Dental Practitioner
Management of Tobacco Use 122 Spit Tobacco Interventions 124 Oral
Substitutes 125 Social Support/Disapproval 125 Medication Management for
Smoking Cessation 126 The Role of Nicotine 126 Pharmacotherapy Options 127
Summary 138 References 138 Resources and Further Readings 140 8 Detection
and Deterrence of Substance Use Disorders and Drug Diversion in Dental
Practice 141 Sarah T. Melton, PharmD, BCPP, BCACP, CGP, FASCP and Ralph A.
Orr Introduction 141 Definitions 141 Screening Patients for Substance Use
Disorder 142 Schemes and Scams to Obtain Prescription Drugs 144 Dental
Practitioner- and Office Personnel-Related Prescription Drug Diversion 147
Prescription Drug Monitoring Programs 148 Disposal of Controlled Substances
153 Universal Precautions in Prescribing Controlled Substances 154 Summary
157 References 157 Resources and Further Readings 158 9 Interviewing and
Counseling Patients with Known or Suspected Substance Use Disorders:
Dealing with Drug-seeking Patients 159 George F. Raymond, DDS and William
J. Maloney, DDS Introduction 159 Definitions 160 Preinterview
Considerations 160 Patient Interview Considerations 161 Interviewing and
Counseling Techniques 162 What Questions Should Be Asked? 163 Screening
Tools 164 Documentation 165 Summary 166 References 166 Resources and
Further Readings 167 10 Office Management of Controlled Substances 169
Carlos M. Aquino Introduction 169 Federal Statutes and Regulations 169
Definitions 169 Common Violations by Dental Practitioners 170 Surviving a
Drug Enforcement Administration Inspection 173 Practice Due Diligence
Program 175 Management of Noncontrolled Substances in the Office 176
Summary 176 Resources and Further Readings 176 11 Addiction and Impairment
in the Dental Professional 177 William T. Kane, DDS, MBA, FAGD, FACD
Introduction 177 Definitions 178 The Complexity of Addiction 178 The
Neurobiology of Addiction 179 The Stigma of Addiction 180 Epidemiology of
Addiction in Dentistry 180 Risk Factors for Substance Use Disorder 180
Substances of Choice 182 Identifying Addiction 183 "The Conspiracy of
Silence" 183 Intervention 184 Evaluation/Assessment 185 Treatment 186
Family and Staff 186 Relapse 187 Monitoring 187 Peer Assistance or Dental
Well-being Committee Programs 187 Summary 189 References 189 Resources and
Further Readings 190 12 Due Diligence and Safe Prescribing 191 Michael
O'Neil, PharmD Introduction 191 Definitions 191 Case Scenarios 192 Summary
205 References 206 Continuing Education Examination 207 Index 213