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A National Epidemic; Local Experience


Katie has been my dental hygienist for the past 20 years. At my most recent "clean and check" visit, she told me about an encounter she had with the health care system.

She said that after experiencing a headache for a couple of days, she started to notice an odd crackly sound in her ear. She decided to have it checked out at the local quick care clinic. The quick care doctor told Katie she had an ear infection that would require antibiotics.

"What is your antibiotic of choice?" he asked her. "A Z-Pac, antibiotic A or antibiotic B. What do you prefer?"

Stunned, she said she just wanted what would be best to treat the infection. When she got to the pharmacy to pick up the antibiotic, the pharmacist began with an apology.

"I'm sorry," he said, "but we don't have enough hydrocodone to fill the doctor's prescription."

Now confused, Katie asked the pharmacist what he was talking about. He told her that the doctor had ordered 50 hydrocodone to treat her headache. She told the pharmacist not to worry about it, because although she mentioned to the doctor she had a headache, she had not sought treatment for it.

Lying in the dental chair with my head below her hands and a metal tool in my wide-open mouth, she asked, "Does this sound odd to you?"

Where to start?

Over and inappropriate prescribing of both antibiotics and opioids are national epidemics and this brief scenario confirms that this problem is alive and well in my community.

Over and inappropriate prescribing of antibiotics:

According to a report from the Centers for Disease Control and Prevention's (CDC) website, "Antibiotics are not recommended to help treat many ear infections," and according to a report published in the Journal of the American Medical Association (JAMA), at least 30% of antibiotics prescribed in the United States are unnecessary.

Over and inappropriate prescribing of antibiotics has resulted in a national epidemic of antibiotic resistance. As a result, the Obama administration released a comprehensive plan that identifies critical actions to be taken by key federal departments and agencies to combat the rise of antibiotic-resistant bacteria. This includes a program that HealthInsight has implemented to improve what is called "antibiotic stewardship" in our communities.

Inappropriate prescribing of opioids:

Hydrocodone (Vicodin) is an opioid pain reliever. Opioid pain relievers are generally safe when taken for a short time and as prescribed by a doctor, but because they produce euphoria in addition to pain relief, they can be misused. Regular use — even as prescribed by a doctor — can lead to dependence and, when misused, opioid pain relievers can lead to overdose incidents and deaths.

Because of the national epidemic of opioid overuse and the dire consequences that have resulted, including thousands of deaths, federal and local agencies have launched initiatives to address this problem. In Nevada, in addition to numerous prevention and treatment plans that have been put in place, and due to the critical nature of this situation, Gov. Brian Sandoval signed AB 474, which allows for disciplinary action against practitioners who inappropriately prescribe opioids.

It goes without saying that asking the patient for their "antibiotic of choice," and prescribing 50 opioid pills, are never appropriate. For more information on this topic, please see the CDC drug overdose hub.

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