美国国家公共电台 NPR Dental Schools Add An Urgent Lesson: Think Twice About Prescribing Opioids

 

ROBERT SIEGEL, HOST:

On the front lines of the opioid crisis, it's a familiar story - the addict¹ whose first exposure to opioids was a legitimate² prescription³ usually from an M.D. but sometimes from a dentist. In 2012, the last year for which we have data, dentists rank number five among primary care providers for opioid prescriptions⁴. In this part of the program - opioids, dentists and pain.

PAUL MOORE: Were in the pain business. People come to see us when they're in pain. Or after we've treated them, they leave in pain.

SIEGEL: Paul Moore teaches at the University of Pittsburgh School of Dental Medicine. He's an advocate for non-opioid pain treatments for dental pain like Advil, Aleve and naproxen.

MOORE: Those agents are every bit as effective as one Vicodin or one Percocet, and that's been shown over and over and over again.

SIEGEL: But Moore recalls making that point to an oral surgeon from Billings, Mont. And he says the oral surgeon reminded him of the business imperatives⁵ of dentistry in a small, competitive market. Here's what Moore says the oral surgeon told him.

MOORE: There are three oral surgeons. And if my referral base found out I didn't prescribe Vicodin, it would be implied that I don't care about their pain after I take out their wisdom teeth, and I'd lose all my business.

SIEGEL: Those are prescriptions for legitimate patients. I went to Massachusetts, which has taken the lead in trying to reduce opioid prescription abuse. A 2016 law controls how health providers can prescribe opioids.

FRED NEWTON: We have 95 residential⁶ beds - long-term treatment.

SIEGEL: Fred Newton runs Hope House, a Boston addiction⁷ treatment center.

NEWTON: Yeah, we have a lot of turnover⁸. As they will tell you, the call of the streets is very strong to them.

SIEGEL: One of the residents is 59-year-old Shawn Bishop⁹. He's been in and out of rehab for a dozen years, and he recalled for me how he learned to play dentists for pills.

SHAWN BISHOP: I have dentures. And I did it accidentally. Actually I went to have some legitimate work done, and I got some Percocets. And I realized that by going to the - another dentist, I could get some more Percocets.

SIEGEL: Addicts¹⁰ frequently forego dental care, so their teeth are often painful. Shawn Bishop recalls a friend and fellow addict named Mark and how they would go to a dentist together.

BISHOP: He would look at our teeth or Mark's teeth in particular - he had bad teeth. He would look at his teeth and say, yeah, we need to take this one, this one and this one. And Mark - oh, well - we'd say, well, I can't do it today; can we make an appointment for next week? And the doctor would say yeah, and he'd write him a prescription of Percocets. And he kept bad teeth and kept tooth aches just so he could do that, you know?

SIEGEL: In Massachusetts, doctors and dentists are now limited to a seven-day supply for the first opioid prescription. They also have to consult the multistate database of prescriptions known as the PMP, the Prescription Monitoring Program, to see if the patient is on any other opioid medication. These new rules are part of a law that was a special cause for Massachusetts Governor Charlie Baker¹¹. And he says there are also rules that mandate¹² teaching about treating pain.

CHARLIE BAKER: At least at the medical school level and the dental school and nursing school of pharmacy¹³ school level. You don't graduate from those places without having studied this stuff and understanding both the positives and negatives associated with using it - in addition to that, making sure that as a condition of re-licensure, you're getting everybody who's writing prescriptions as part of that process.

SIEGEL: Baker was persuaded to address this issue after campaigning and hearing the stories people told of an overdose or at least an addiction in the family, an addiction that often started with a prescription.

BAKER: Twenty, 30, 40 pills, 50, 60 pills, which are the kinds of numbers I was hearing about when I was out and about as a candidate from a lot of these moms and dads. You know, we created a whole community here of people who literally¹⁴ had their body chemistry altered by the amount of this pain medication they were taking.

SIEGEL: Reducing the size and number of these prescriptions could mean using less dangerous, non-addictive painkillers¹⁵. But it could also mean talking with patients differently about pain. For decades, health care providers, having been criticized for under-treating pain, prescribed more and more opioids. Well, now the pendulum¹⁶ is swinging back. David Keith, an oral surgeon at Massachusetts General Hospital, says the aim of being pain-free sounds great, but...

DAVID KEITH: I think it does us a disservice, making us and the patients assume that they should have a total smiley face and a zero level of pain. That's not the real world. And so we take a tooth out. We do a dental implant¹⁷. You're going to be sore for a couple of days, but that doesn't mean you can't go to work.

SIEGEL: Dr. Keith told me that he heard some resistance from dentists to writing smaller prescriptions. What argument does he hear in favor of describing 20 pills instead of five, six or seven after an extraction?

KEITH: Because I've always done it that way (laughter) - is the usual answer. And I think you've hit on the problem here or at least one of the problems.

SIEGEL: And one of the solutions being tried is to teach new dentists to do it differently.

JEFF SHAEFER: So this is the teaching practice. So this is where we have actually post-graduates. We have programs in all the different dental specialties¹⁸.

SIEGEL: Jeff Shaefer teaches pain management at Harvard School of Dental Medicine. He took part in writing the core competencies in prescription drug misuse¹⁹ that Massachusetts dental students now have to demonstrate. They have to learn how to screen for substance abuse and how to refer a patient for treatment.

SAM LEE: I'm going to put your temporary crown back on, and then we'll check the occlusion, make sure everything is OK when you bite down.

SIEGEL: That's fourth-year dental student Sam Lee at the teaching practice at Harvard Dental School. Lee was one of a group of fourth-year students I sat down with.

KELLIE MOORE: Kellie Moore - nice to meet you.

SIEGEL: Kellie Moore...

DAISY JI: Daisy Ji - how are you?

SIEGEL: Daisy, nice to meet you.

JON SHAPIRO: Jon Shapiro.

LEE: Samuel Lee - nice to meet you - good.

SIEGEL: Lee and his fellow dental students like Daisy Ji have to be taught about prescribing opioids and assessing patients for substance use disorder²⁰.

JI: This is something that our predecessors²¹ really haven't had to deal with until recently. And I think dentists are, for example, one of the highest prescribers of opioids. So I think we're all having a shift in terms of perspective of how to treat pain away from opioids.

SIEGEL: I asked the dental students what they've learned about pain. Kellie Moore works at a community health center.

MOORE: You can approach it from opioid therapy. You can approach it from different neuropathy drugs. You can approach it from stretching exercises to meditation²² to stress for - and just kind of, like, exhausting all of the options with the patient and exploring what works for a patient and what doesn't.

SIEGEL: Sam Lee says it's important to lower expectations of a perfectly²³ pain-free outcome.

LEE: On a scale of zero to 10 with 10 being the worst, if we can get you to maybe a four or a five, could you live with that and still function daily? And if the answer is yes, then I think it's important to have that patient understand that that's what we're going to try and maintain as the new normal for them.

SIEGEL: And Jon Shapiro comes away with the wisdom that pain is relative.

SHAPIRO: This morning, I just came from scaling a root planing. I was digging into this guy's gums and just cleaning everything out - and blood everywhere, didn't flinch²⁴. He didn't even need anesthesia. But then I've had other patients where you can just touch their tooth, and they'll jump. They'll scream. They'll just say it hurts. And so pain is relative, but it's also really difficult to quantify.

SIEGEL: And that's a dilemma²⁵ dentists face. We experience pain in very individual ways. The prescription we get for pain shouldn't just be so big that it covers all possibilities. Again, professor Jeff Shaefer of Harvard Dental School...

SHAEFER: Dentistry is part of the problem, and I think that hurts - that we've been overprescribing medications. And you know, having a standard regimen to give every patient is not appropriate.

SIEGEL: He offered this measure of the urgency of teaching addiction issues to all dental students in the nation. Typically, Shaefer told me, a new standard may be phased in over time. This summer, the Commission on Dental Accreditation²⁶ said, start doing it right away.

(SOUNDBITE OF DEAN WAREHAM AND BRITTA PHILLIPS' "MOM'S")

1 addict   

v.使沉溺；使上瘾；n.沉溺于不良嗜好的人

参考例句：

• He became gambling addict,and lost all his possessions.他习染上了赌博，最终输掉了全部家产。
• He assisted a drug addict to escape from drug but failed firstly.一开始他帮助一个吸毒者戒毒但失败了。

2 legitimate   

adj.合法的，合理的，合乎逻辑的；v.使合法

参考例句：

• Sickness is a legitimate reason for asking for leave.生病是请假的一个正当的理由。
• That's a perfectly legitimate fear.怀有这种恐惧完全在情理之中。

3 prescription   

n.处方，开药；指示，规定

参考例句：

• The physician made a prescription against sea- sickness for him.医生给他开了个治晕船的药方。
• The drug is available on prescription only.这种药只能凭处方购买。

4 prescriptions   

药( prescription的名词复数 )； 处方； 开处方； 计划

参考例句：

• The hospital of traditional Chinese medicine installed a computer to fill prescriptions. 中医医院装上了电子计算机来抓药。
• Her main job was filling the doctor's prescriptions. 她的主要工作就是给大夫开的药方配药。

5 imperatives   

n.必要的事( imperative的名词复数 )；祈使语气；必须履行的责任

参考例句：

• Nixon, however, had other imperatives. 但尼克松另有需要。 来自辞典例句
• There could be some cultural imperatives in there somewhere! 在公共传播那里，在某些方面，可能有更迫切的文化需要！ 来自互联网

6 residential   

adj.提供住宿的；居住的；住宅的

参考例句：

• The mayor inspected the residential section of the city.市长视察了该市的住宅区。
• The residential blocks were integrated with the rest of the college.住宿区与学院其他部分结合在了一起。

7 addiction   

n.上瘾入迷，嗜好

参考例句：

• He stole money from his parents to feed his addiction.他从父母那儿偷钱以满足自己的嗜好。
• Areas of drug dealing are hellholes of addiction,poverty and murder.贩卖毒品的地区往往是吸毒上瘾、贫困和发生谋杀的地方。

8 turnover   

n.人员流动率，人事变动率；营业额，成交量

参考例句：

• The store greatly reduced the prices to make a quick turnover.这家商店实行大减价以迅速周转资金。
• Our turnover actually increased last year.去年我们的营业额竟然增加了。

9 bishop   

n.主教，（国际象棋）象

参考例句：

• He was a bishop who was held in reverence by all.他是一位被大家都尊敬的主教。
• Two years after his death the bishop was canonised.主教逝世两年后被正式封为圣者。

10 addicts   

有…瘾的人( addict的名词复数 )； 入迷的人

参考例句：

• a unit for rehabilitating drug addicts 帮助吸毒者恢复正常生活的机构
• There is counseling to help Internet addicts?even online. 有咨询机构帮助网络沉迷者。 来自超越目标英语 第3册

11 baker   

n.面包师

参考例句：

• The baker bakes his bread in the bakery.面包师在面包房内烤面包。
• The baker frosted the cake with a mixture of sugar and whites of eggs.面包师在蛋糕上撒了一层白糖和蛋清的混合料。

12 mandate   

n.托管地；命令，指示

参考例句：

• The President had a clear mandate to end the war.总统得到明确的授权结束那场战争。
• The General Election gave him no such mandate.大选并未授予他这种权力。

13 pharmacy   

n.药房，药剂学，制药业，配药业，一批备用药品

参考例句：

• She works at the pharmacy.她在药房工作。
• Modern pharmacy has solved the problem of sleeplessness.现代制药学已经解决了失眠问题。

14 literally   

adv.照字面意义，逐字地；确实

参考例句：

• He translated the passage literally.他逐字逐句地翻译这段文字。
• Sometimes she would not sit down till she was literally faint.有时候，她不走到真正要昏厥了，决不肯坐下来。

15 painkillers   

n.止痛药( painkiller的名词复数 )

参考例句：

• The doctor gave him some painkillers to ease the pain. 医生给了他一些止疼片以减缓疼痛。 来自辞典例句
• The primary painkillers - opiates, like OxyContin - are widely feared, misunderstood and underused. 人们对主要的镇痛药——如鸦片剂奥施康定——存在广泛的恐惧、误解，因此没有充分利用。 来自时文部分

16 pendulum   

n.摆，钟摆

参考例句：

• The pendulum swung slowly to and fro.钟摆在慢慢地来回摆动。
• He accidentally found that the desk clock did not swing its pendulum.他无意中发现座钟不摇摆了。

17 implant   

vt.注入，植入，灌输

参考例句：

• A good teacher should implant high ideals in children.好教师应该把高尚理想灌输给孩子们。
• The operation to implant the artificial heart took two hours.人工心脏植入手术花费了两小时。

18 specialties   

n.专门，特性，特别；专业( specialty的名词复数 )；特性；特制品；盖印的契约

参考例句：

• Great Books are popular, not pedantic. They are not written by specialists about specialties for specialists. 名著绝不引经据典，艰深难懂，而是通俗易读。它们不是专家为专业人员撰写的专业书籍。 来自英汉 - 翻译样例 - 文学
• Brain drains may represent a substantial reduction in some labor force skills and specialties. 智力外流可能表示某种劳动力技能和特长大量减少。 来自辞典例句

19 misuse   

n.误用，滥用；vt.误用，滥用

参考例句：

• It disturbs me profoundly that you so misuse your talents.你如此滥用自己的才能，使我深感不安。
• He was sacked for computer misuse.他因滥用计算机而被解雇了。

20 disorder   

n.紊乱，混乱；骚动，骚乱；疾病，失调

参考例句：

• When returning back,he discovered the room to be in disorder.回家后，他发现屋子里乱七八糟。
• It contained a vast number of letters in great disorder.里面七零八落地装着许多信件。

21 predecessors   

n.前任( predecessor的名词复数 )；前辈；（被取代的）原有事物；前身

参考例句：

• The new government set about dismantling their predecessors' legislation. 新政府正着手废除其前任所制定的法律。 来自《简明英汉词典》
• Will new plan be any more acceptable than its predecessors? 新计划比原先的计划更能令人满意吗？ 来自《简明英汉词典》

22 meditation   

n.熟虑，（尤指宗教的）默想，沉思，（pl.）冥想录

参考例句：

• This peaceful garden lends itself to meditation.这个恬静的花园适于冥想。
• I'm sorry to interrupt your meditation.很抱歉，我打断了你的沉思。

23 perfectly   

adv.完美地，无可非议地，彻底地

参考例句：

• The witnesses were each perfectly certain of what they said.证人们个个对自己所说的话十分肯定。
• Everything that we're doing is all perfectly above board.我们做的每件事情都是光明正大的。

24 flinch   

v.畏缩，退缩

参考例句：

• She won't flinch from speaking her mind.她不会讳言自己的想法。
• We will never flinch from difficulties.我们面对困难决不退缩。

25 dilemma   

n.困境，进退两难的局面

参考例句：

• I am on the horns of a dilemma about the matter.这件事使我进退两难。
• He was thrown into a dilemma.他陷入困境。

26 accreditation   

n.委派，信赖，鉴定合格

参考例句：

• a letter of accreditation 一份合格证明书
• This paper gives an overview of the Verification, Validation and Accreditation (VV&A) in High Level Architecture(HLA). 对基于高层体系结构(High Level Architecture,简称HLA)的仿真系统的校核、验证与确认(Verification, Validation and Accreditation,简称VV&A)问题进行了详细的介绍及分析。 来自互联网