Recognition of At-risk Patients

Identification of patients who may be at-risk for diversion and/or misuse of medications is the responsibility of healthcare providers as part of caring for their patients. A complete history and physical, including assessment of alcohol, tobacco, prescription, history of current or chronic pain, history of mental health treatment, and illicit drug use allows a fuller picture of potential patient-related risk factors.^17,92 The percentage of dentists assessing these conditions varies widely (Table 1) and may result in dental healthcare providers failing to identify patients at higher risk of opioid misuse.¹⁵ Dentists generally utilize written questionnaire for health screening, but a recent study found that these may be incomplete and not allow for comprehensive risk assessment.¹⁷  A verbal review of risk factors and health conditions associated with drug misuse and abuse can be conducted by members of the dental team to allow for individualized approaches to pain management in the dental office. Screening tools for identification of risk of opioid misuse/abuse have been identified, but the validity and predictive value of such screening tools is not yet known.^93-95

Table 1. Dentist Assessments of Various Health Conditions that can be Associated with Substance Misuse and Abuse Disorders.¹⁷

Table 1. Dentist Assessments of Various Health Conditions that can be Associated with Substance Misuse and Abuse Disorders.¹⁷