CHAPEL HILL, N.C. — The state of North Carolina is taking legal and medical steps to move forward from the opioid epidemic.
Where, when, why and how painkillers are prescribed is not only changing but, in some cases, may even be eliminated.
What You Need To Know
- The UNC Dental and Pharmacy Schools have a partnership
- Dr. Kimberly Sanders is a clinical pharmacist
- Sanders is housed in the Adams School of Dentistry
- She advises dental students on pain management
- The NCDHHS recently released updated guidance on combatting opioids in dental settings
Fields of medicine like dentistry will look to other fields like pharmacy to stop abuse before it starts.
The North Carolina Department of Health and Human Services released an updated dental opioid action plan in late November, which details an overhauled approach to pain management.
As the state’s top health agency pushes for stricter parameters, so has the state’s top law enforcement officer.
Last week, State Attorney General Josh Stein announced a nearly $11 billion settlement with Walgreens and CVS.
The negotiation includes attorney generals from 18 states.
At a local level, Durham County is already receiving its part of a $26 billion agreement from a separate national opioid lawsuit.
A N.C. County Commissioners Report on the Opioid Litigation Settlement Overview stated funding for municipal governments may only be used for the care, treatment and recovery from opioid addiction.
The prevention of another crisis started before the pandemic at the University of North Carolina Adams School of Dentistry.
Dr. Kimberly Sanders has spearheaded the integration of clinical pharmacy into the dental school’s clinics.
“Coming from the research side, I was really looking for ways in which there are models or services from pharmacy that could benefit dental practice,” Sanders said.
Sanders is a clinical pharmacist who joined the faculty at UNC in 2016. “What the rest of (the) body has going on impacts our dental care,” Sanders said.
The pharmacist said the collaboration between the dental school and Eshelman School of Pharmacy began before the pandemic, and she believes the relationship between the fields cannot be dismissed.
“That is strongly represented in the types of medication side effects and impacts that occur. To kind of just glance over that would be a real disservice to health care because so many medications impact oral care,” Sanders said.
Sanders actively works with dental students every semester.
To the pharmacist turned professor, her message is to treat the mouth as the gateway to the body.
Her experience amplified the growth of Caroline Meier, a 25-year-old fourth year dental school resident who treats patients from all over the state as part of her coursework.
A semester away from graduation, Meier said good dental health makes people feel good about themselves. It’s the reason she is becoming a dentist. She embraces the patient-provider dynamic.
“Oh, it’s very important,” Meier said. “Because you read about things in a book and how to approach problems, but then the patient will tell you something. It’s important to know kind of what they’re feeling.”
In this field, you learn by doing, listening and troubleshooting, and this resident has grown used to staying on her toes.
“It’s kind of the luck of the draw,” Meier said.
The feedback Sanders provides about the best ways to address pain management has been instrumental.
“Because an expectation will be your annual opioid prescribing continuing education,” Sanders said.
The pharmacist often discusses patient treatment plans.
“One of the areas though that hasn’t necessarily been as explored is the dental setting. I think historically the dental setting has been a bit more siloed from other health professions,” Sanders said.
Sanders saw an opportunity when she came to Chapel Hill to reduce gaps in care and share insights about medication use.
Sanders describes medication use as a complex process, including everything from communicating the side effects of a drug to understanding the background of the person who you are prescribing a drug.
The medical charts in their clinic are full of folks from all walks of life across North Carolina.
“From the mountains to the ocean,” Sanders said.
The doctor implements strategies like risk mitigation—the practice of reevaluating which medications and doses a patient needs to reduce their pain.
The clinics also preview what students can expect in the real world. She said in this setting, education is a two-way street between the future clinicians and the people they may treat.
“(We) provide them that opportunity to be like, oh, wow, we could really expand on educating patients, educating dental students to know what to look for and see in their patient,” Sanders said.
When NCDHHS adopted revised standards to combat opioids, the dental school’s curriculum was ahead of the curve. The students garner practical training in considering alternatives to treating pain, reviewing a person’s medical portfolio and checking for a history of abusing prescriptions.
All of this is knowledge a fourth-year resident like Meier will soon carry into her career.
Sanders believes integrating different realms of health care can equal better practices of medicine over time, and said changes in postoperative care most benefit oral surgery when prescribing pain medication.