In early 2016, under Tu’s leadership, the Minnesota dental school introduced a mandatory protocol stipulating that the first-line treatment for pain would be nonsteroidal anti-inflammatory drugs such as high-dose ibuprofen. Opioids were permissible after a difficult surgery, but providers had to use the lowest adequate dose and register the prescription in a digital tracking system.
The result: in 15 months the school’s 30 practitioners cut opioid prescriptions nearly in half, according to a report to be published later this year. Nevertheless, they saw no increase in after-hours calls or return visits related to pain. Since the study was completed, opioid use has further plummeted, Tu says: in 2015 95 percent of painkillers prescribed after a procedure were opioids; in 2017 it was just 21 percent. The average number of opioid pills per patient also dropped—an important change because unused pills often go astray. Surveys show that dentists typically prescribe 16 to 24 opioid pills, and yet patients use about eight.