C.E. Credit. Harm Reduction: A Strategy to Improve Outcomes for Dental Patients with Substance-Use Disorders

Figures & data

Figure 1. California opioid prescriptions, per 1,000 residents, 2009–2021.²³

Reprinted with permission from the California Department of Public Health, California Overdose Surveillance Dashboard²³ (permission granted on January 19, 2023).

Figure 2. California drug-related overdose deaths, per 100,000 residents, 2007–2022.²³

Reprinted with permission from the California Department of Public Health, California Overdose Surveillance Dashboard²³ (permission granted on January 19, 2023).

Table 1. Clinician Administered Screening Tools | Source National Institute on Drug Abuse.⁵⁸

Tool	Drugs Screened	Age	Identifiers	Source
TAPS	Tobacco, Alcohol, Prescription medication, and other Substance use	Adults	Level of risk for each drug during past 90 days of use	https://nida.nih.gov/taps2/
BSTAD	Brief Screener for Tobacco, Alcohol, and other Drugs	Adolescents (12–17)	Risky substance abuse	https://nida.nih.gov/bstad/
ORT	Opioid Risk Tool	Adults	Level of risk for abuse before initiating opioid therapy for pain management	https://nida.nih.gov/sites/default/files/opioidrisktool.pdf

Table 2. Basic Tenets of Motivational Interviewing (OARS).⁶²

Use open-ended questions: Allows patients to tell their story including ambivalence, perceived challenges, and motivation for behavior change	“What do you like about the drug?” “Are there things about your drug use that you have not liked?” and “Can you tell me more?”
Use affirming statements: Recognizes patients’ strengths and efforts toward less harmful behaviors	“I appreciate your willingness to discuss this with me,” “It took a lot of courage for you to share this with me.”
Listen reflectively and respond with empathy: Creates an environment of trust between patient and dentist.	“If I heard you, your drug use started after you got a divorce. That must have been a very difficult time for you.”
Summarize discussion: Allows patient to hear from a different “voice” their insights, challenges, ambivalence and motivation for harm reduction	“I would like to summarize what I heard so far”, “Please let me know if I got it right or if there is something more that you would like to add.”
Elicit self-motivating statements: Explores incremental actions that might reduce harm	“Is there anything about your drug use that you would like to change or that would make it safer for you?” “What do you perceive to be the challenges and advantages to making these changes?”

Table 3. Patient Resources for Naloxone in California.⁶⁶

Source	Details	Contact Information
Next Distro	Free/Mail order	https://nextdistro.org/cachoice
Pharmacy Naloxone Access in California	Price varies by pharmacy/Pick up	https://drugpolicy.org/pharmacy-naloxone-access-california
Naloxone Finder	Free/Pick up at community- based naloxone distribution sites	https://harmreduction.org/resource-center/harm-reduction-near-you/

Table 4. Treatment Referral Resources | Source Substance Abuse and Mental Health Services Administration,⁷⁰ California Dental Association.⁷¹

Resources	Information	Contact Information
Treatment Locator	Finds treatment facilities by zip code, distance, facility name and requested services 24/7	800–662-HELP (4357) Text zip code to HELP4U (435748) www.treatmentfinder.com
Find a Physician	Finds a physician listed on the American Society of Addiction Medicine website	https://www.asam.org/publications-resources/patient-resources
California Mental Health Crisis Hotline	Connects individuals with mental health specialist 24/7	1-866-903-3787 https://mentalhealthhotline.org/california/
California Dental Association Wellness Program	Provides substance use and mental health support and assistance for dental professionals	So. California: 310-487-5040 San Diego: 619-275-7190 No. California: 530-864-4264 Bay Area: 510-209-5637 Central California: 916-947-5676 https://www.cda.org/Wellness-Program

California Department of Public Health. California dashboard. California overdose surveillance dashboard. https://skylab.cdph.ca.gov/ODdash/. Published July 19, 2022. Accessed September 13, 2022.

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National Institute on Drug Abuse. Screening tools and prevention. validated screening tools. https://nida.nih.gov/nidamed-medical-health-professionals/screening-tools-prevention. Updated 2019-01-19. Accessed August 12, 2022.

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Building rapport with patients: OARS communication skills. Rockville, MD: Agency for Healthcare Research and Quality; 2018. https://www.ahrq.gov/evidencenow/tools/oars-model.html. Accessed January 8, 2023.

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Find harm reduction services near you. National Harm Reduction Coalition. https://harmreduction.org/resource-center/harm-reduction-near-you/. Accessed August 12, 2022.

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Behavioral health and services treatment locator. Substance Abuse And Mental Health Services Administration; 2022. https://findtreatment.samhsa.gov/. Accessed August 12, 2022.

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Wellness Program. California Dental Association. https://www.cda.org/Wellness-Program. Accessed January 13, 2023.

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