Empowering dentists to reduce opioid prescriptions to young people

摘要 牙医是青少年和年轻人（AYAs）阿片类药物的主要处方者，尽管阿片类药物的使用 拔牙后的疼痛与疼痛控制或满意度的改善无关。在AYAs中，阿片类药物处方 在牙科手术后使用阿片类药物会增加阿片类药物滥用，使用障碍和过量的风险。的长期目标 该项目旨在制定一个框架，以减少用于治疗急性牙痛的阿片类药物处方。 本提案的目的是确定多方面干预措施的有效性， AYA拔牙后的牙科阿片类药物处方率我们的中心假设是， 需要进行干预，以显著减少对AYA的提取后阿片类药物处方。的 这一建议的基本原理是多成分干预将解决提供者的知识， 激励和选择架构优于单一成分策略;将吸引和教育患者; 并将提供用于分发的实物而不是阿片类药物处方。我们将通过以下方式检验这一假设： 追求四个具体目标：在UG 3期间，1）完成必要的初步工作，以测试新方法 管理牙科治疗后的急性疼痛，并在UH 3期间：1）建立一种新的 教育和药物分配方法，使用学术细节，患者教育和泡罩包装 非阿片类镇痛药，以减少AYA拔牙后的阿片类处方; 2）检查关键 旨在改变牙科专业决策行为的干预措施的实施结果; 和3）评估拔牙后患者报告的疼痛管理、镇痛剂使用和药物处置。到 为了实现这些目标，我们提出了一个社区和学术诊所的阶梯楔形群随机试验， 在整个肯塔基州使用一对一的供应商教育加上供应商分布的创新干预， 患者教育材料和含有对乙酰氨基酚和布洛芬的标准化泡罩包装。本研究 将在肯塔基州至少10个最大的口腔外科诊所进行，至少招募27名 预计提供者将为超过40，000名AYA进行拔牙。我们将使用 患者水平二元指标（处方阿片类药物）的主要终点。次要终点 包括干预可接受性、适当性、可行性和保真度（UH 3目标2）;以及患者报告疼痛， 疼痛干预、镇痛药使用和药物处置（UH 3目标3）。这项研究意义重大，因为 它将为大规模实施干预措施提供一个框架， 行为对急性疼痛管理的循证建议，导致减少 拔牙后的阿片类药物处方率。预期成果是制定一个框架， 干预措施，以减少牙科阿片类药物处方的AYA。结果将立即产生积极影响 因为它们将限制不必要的阿片类药物暴露，长期而言，因为它们将帮助牙科建立一个 减少美国物质使用障碍影响的框架。

ABSTRACT Dentists are the leading prescriber of opioids to adolescents and young adults (AYAs), even though opioid use after tooth extraction is not associated with improved pain control or satisfaction. In AYAs, an opioid prescription after a dental procedure increases the risk of opioid misuse, use disorder, and overdose. The long-term goal of this project is to develop a framework to reduce opioid prescriptions to AYAs for treatment of acute dental pain. The objective of this proposal is to establish the effectiveness of a multicomponent intervention at reducing dental opioid prescription rates after tooth extraction in AYAs. Our central hypothesis is that a multicomponent intervention is required to produce significant reductions in post-extraction opioid prescriptions to AYAs. The rationale underlying this proposal is that a multicomponent intervention will address provider knowledge, motivation, and choice architecture better than a single-component strategy; will engage and educate patients; and will provide a physical item for distribution instead of an opioid prescription. We will test this hypothesis by pursuing four specific aims: in the UG3 period, 1) complete requisite preliminary work to test a new approach to manage acute pain following dental treatment, and in the UH3 period: 1) establish effectiveness of a novel educational and drug-dispensing approach using academic detailing, patient education, and blister-packaged non-opioid analgesics to reduce opioid prescriptions following tooth extraction among AYAs; 2) examine key implementation outcomes of the intervention designed to modify dental professional decision-making behaviors; and 3) assess patient-reported pain management, analgesic use, and drug disposal after tooth extraction. To accomplish these aims, we propose a stepped wedge cluster randomized trial of community and academic clinics across Kentucky using an innovative intervention of one-on-one provider education plus provider distribution of patient education materials and standardized blister packs containing acetaminophen and ibuprofen. This study will be conducted across at least 10 of the largest oral surgery practices in Kentucky, enrolling at least 27 providers expected to perform tooth extractions on over 40,000 AYAs. We will assess effectiveness using a primary endpoint of the patient-level binary indicator of being prescribed an opioid. Secondary endpoints include intervention acceptability, appropriateness, feasibility, and fidelity (UH3 aim 2); and patient-reported pain, pain interference, analgesic use, and drug disposal (UH3 aim 3). The proposed research is significant because it will provide a framework for wide-scale implementation of interventions to modify dental decision-making behaviors towards evidence-based recommendations for acute pain management, resulting in a reduction in opioid prescription rates after tooth extraction. The expected outcome is a framework to implement effective interventions to reduce dental opioid prescribing to AYAs. The results will have a positive impact immediately because they will limit unnecessary opioid exposure, and long-term because they will help dentistry build a framework for reducing the impact of substance use disorders across the United States.