The Neutral Zone

Next week, I’m giving a presentation at The Dental Festival in Miami on “Courageous Conversations: How Dental Professionals Can Positively Impact the Opioid Crisis.” This week, I spent some time updating my research and am happy to report that the numbers of prescriptions written for opiates by dental professionals has decreased. Our industry, along with other healthcare providers on the frontlines, have educated ourselves and are clearly committed to making a difference. That’s the good news.

The bad news is not only are we still losing a record number of people to opiate overdoses but also the pandemic has made it worse, not better. According to the CDC, more than 80,000 people died from a drug overdose between June 1, 2019 and May 31, 2020. That’s an 18.2% increase and is the largest number of drug overdoses for a 12-month period ever recorded. Clearly, there is still much to do.

But what else can we do? I believe in addition to following recommended guidelines for prescribing, we can communicate with patients at an entirely different and much more courageous level. In our communication coaching sessions with practices to improve their treatment acceptance, we spend a fair amount of time on improving the patient interview. It’s here that we frequently observe how our underlying beliefs seep into and influence our actual communication with patients about seemingly uncomfortable health issues such as psychiatric problems, sexually transmitted diseases, and drug use.

It’s not hard to observe when someone holds beliefs such as these:

  • Only bad people abuse drugs.
  • Addiction is an outcome of a lack of self-control and bad choices.
  • No person with a history of drug problems would ever admit to it so asking questions is useless.
  • A person with drug issues will be uncomfortable, embarrassed, insulted, or potentially hostile if you ask them direct questions about their drug use.

I’m not suggesting that these beliefs are unfounded. What I am suggesting is that whatever life experience we’ve had with drug use in our families or communities has most certainly influenced our beliefs about and relationship with the subject. If we have insecurities about communicating well in conflict and we believe that the subject of drug use is fraught with inherent conflict, we’ll avoid it altogether or, at best, enter into the conversations with a serious lack of confidence.

I also know that there are a number of patients who come to our offices seeking drugs to feed an addiction and/or to sell. And while they will not likely be honest in an interview, if we know the signs to look for, their behavior usually gives them away, and we can respond appropriately. But, many patients who are using drugs would stop if they could. And many that have a history of drug abuse are in a daily fight for their sobriety, and one small mistake could make all the difference. It is with these patients that we have such a huge opportunity to make a positive impact.

I believe that if we sign up to be frontline healthcare providers, it is our duty to examine our beliefs, suspend our judgment, and shift into neutral when communicating with patients about their history with drugs and other socially uncomfortable subjects… because patients’ answers matter. Among other things, their family history, previous and current lifestyle, and attitudes toward drugs all impact their risk. Studies show that a surprisingly high percentage of patients with a history of drug use or those who are currently using will have an open dialogue with a healthcare professional about it.

It’s also essential, when we do decide to prescribe narcotics, that we know how to counsel patients and/or their parents about the risks and proper use of these drugs as well as responsible storage and disposal of unused medications.

These conversations take knowledge, discussion, practice, and courage to manage well, but the outcome is worth the trouble. We save lives and families when we do our part to interview well, prescribe responsibly, and counsel our patients wisely. This week, talk with your team about how you can improve your interviewing skills with patients. Have an open discussion in terms of your role as patient educators about the risks, responsibilities, and resources for using these potent and dangerous drugs.

If you need guidance, consider enrolling in this upcoming workshop, given by my colleague, Dr. Ronni Brown. She has dedicated her entire career to helping dental teams with the knowledge and skills associated with prescription and illicit drugs so that they can make a positive difference in the lives of their patients. She also has a new book out A State of Decay, a must read for every dental team in the nation committed to doing their part in this national crisis.

Book: A State of Decay

Breaking Bad and Breaking Through Workshop

“Jumping to conclusions is often the only exercise some people get and is always easier than finding the patience to discover the truth.”
~ Karen White