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medication-assisted treatment have a half-life that is much longer than that of immediate release opioids. This leads to decreased efficacy of opioids used in the acute dental setting, but could contribute to greater risk of adverse effects. Opioids should be avoided in this population. If opioid therapy is necessary for adequate pain control, higher doses of opioids or more frequent dosing intervals are necessary for the treatment of acute pain, which leads to a substantially higher risk of overdose death. The risks of such medications likely outweigh the efficacy of opioids in this setting. Opioid agonists include: • methadone (Dolophine®, Methadose®) • buprenorphine (Buprenex®, Probuphine®,Buprenex®, Belbuca®, Butrans®) • buprenorphine/naloxone (Bunavail®, Suboxone®, Zubsolv®) o Chlorhexidine gluconate without alcohol should be utilized (if indicated). Substance Use Disorders 38 o Dentists should consider screening, brief intervention, and referral to treatment (SBIRT) for patients with substance use disorders. https://www.ihs.gov/asap/sbirt/ o Opioid medications should be avoided due to unknown interactions with illicit substances, and propensity of opioid medications to contribute to dependence. o Chlorhexidine gluconate without alcohol should be utilized (if indicated). Pregnancy 55 o Acetaminophen is the recommended first-line analgesic in pregnant women. o Avoid the use of long-acting local anesthetics (use Lidocaine only). o NSAIDs should be used minimally during 1st trimester and avoided during the 3rd trimester of pregnancy. o Opioids should be avoided. If Acetaminophen alone does not adequately control pain, the patient’s primary care provider or obstetrician should be consulted to discuss pain control options. Renal impairment o Codeine should be avoided for all patients with renal impairment. o NSAIDs should be avoided if: • Creatinine Clearance [CrCl] Introduction This guideline was developed in collaboration with a broad advisory group of the state’s academic leaders, pain experts, and dentists in general care and specialty areas in response to the growing epidemic of opioid‐related overdoses and supplements the Agency Medical Director’s Group (AMDG) Interagency Guideline on Prescribing Opioids for Pain. The guideline is based on the best available clinical and scientific evidence from the literature and a consensus of expert opinion. This is an easy‐to‐use reference to help dentists, oral surgeons, and others follow a set of clinical recommendations and access supporting evidence and resources in the appendices to align opioid prescribing with current evidence. We recommend revising office‐prescribing practices as necessary to be consistent with this guideline, the American Dental Association (ADA) statement, and the Centers for Disease Control and Prevention (CDC) guideline. We also recommend considering the feasibility of embedding key practices from these guidelines into electronic health record systems. Lastly, we recommend educating office staff and patients about the risks and benefits of opioids, individualizing pain management strategies for each patient’s clinical situation, and avoiding “just in case” prescribing. Dentists Play a Critical Role The United States is experiencing a dramatic increase in prescription (both prescribed and for non‐ medical use) opioid overdose deaths, primarily among 35 to 55 year olds.1,2 The majority of new heroin users start out with prescribed opioids.3 While the exact number of opioids