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opioid diversion and the importance of secure storage of their medications. b. Share information on prompt disposal of leftover opioids through community‐based drug take back programs, a DEA‐approved take back program or FDA guideline for safe disposal of medicine. c. Advise the patient to avoid combining opioids with benzodiazepines, sedative‐hypnotics, anxiolytics, or other central nervous system depressants, including alcohol. These combinations exponentially (not just additively) increase risk for dangerous respiratory depression. Evidence Opioids are efficacious analgesics for severe acute pain and are widely used for this purpose. However, opioids do not have anti‐inflammatory properties, so non‐opioid analgesics (e.g., NSAIDs) can be a better first choice for pain relief.11 In addition, opioids carry many risks, including physical tolerance, dependence, addiction, and overdose.12 That patients do not use or need most of the opioids prescribed for acute pain is clear.4,5 Children undergoing minor medical procedures other than dental extractions had the majority of initially prescribed opioid doses leftover by day four. 13 For example, an average of 52 opioid tablets are dispensed after tonsillectomy and an average of 44 tablets go unused. Often, these leftover opioid tablets are later misused for non‐medical purposes.4 Even in the case of common major elective surgeries, the majority of currently prescribed post‐operative opioids go unused; as few as five‐ 15 tablets sufficed for 80% of patients after physician education led to substantial reductions in prescribed doses.14 Although it is not known exactly how many opioid doses taken during acute pain episodes may lead to increased risk of dependence or subsequent misuse, a recent observational study using a large commercial database suggests that even a few days of opioids can increase risk. The risk of being on opioids at one year increases about one percent for each day of opioid supplied, starting with a three days’ supply of an initial prescription.15 Prudent practice encourages the prevention of pain, where possible, by administering non‐opioid analgesics before pain occurs. Efficacy is seen with preemptive and concurrent use of NSAIDs and acetaminophen, around the clock for as many days as necessary. In some studies, analgesic regimens using NSAIDs and acetaminophen have demonstrated pain relief comparable to hydrocodone/acetaminophen 5/325mg.16 Moore and Hersh, in a systematic review of the evidence for dental extractions, concluded that, “the ibuprofen‐APAP combination may be a more effective analgesic, with fewer untoward effects, than are many of the currently available opioid‐containing formulations.”17 These authors also concluded that the ibuprofen‐acetaminophen combination is more effective than either drug alone. Another systematic review of analgesic efficacy to treat pain of endodontic origin recommends NSAIDs as the drug class of choice for pain of endodontic origin as long as there is no Dental Guideline on Prescribing Opioids for Acute Pain Management Adopted by the Bree Collaborative, September 27th, 2017 Page 6 of 12 contraindication for such use. 18 Moderate evidence supports use of pre‐operative NSAIDs to reduce inflammation and post‐operative analgesic requirements.19,20 Providers should be aware that NSAIDs and acetaminophen also have potential for serious adverse outcomes.21,22 If use of an opioid for acute pain is warranted,