In brief: Opioid use, toothbrush bacteria, and Medicaid reform

New injectable to reduce opioid abuse and pain following oral surgery

On November 4, Balanced Pharma Incorporated (BPI) announced that it acquired the rights to Enduracaine Dental for the worldwide dental market. This product is a new, nonopioid injectable meant to treat postsurgical pain for procedures such as wisdom tooth extraction.¹

Originally introduced to the surgical market in 2023 as Endura-KT, Enduracaine consists of tetracaine 0.2%, lidocaine 0.4%, and epinephrine 1:250,000. Although it was originally well received by practitioners, the initial version of this product (as a compounding kit) had refrigeration, reconstitution, and shelf-life issues.¹

Now, however, Balanced Pharma believes Enduracaine Dental has the potential to greatly reduce the number of patient opioid prescriptions. This may be a game changer for the dental industry, especially since 94% of patients currently receive opioid prescriptions after having their wisdom teeth out. These same patients are at an alarming 14 times greater risk of developing subsequent opioid abuse.¹

According to Scott Keadle, DDS, retired dentist and CEO of BPI: "If we can give doctors a safe, nonopioid drug with three days of analgesia for their patients, in a standard dental cartridge that is efficient for their practice, that is an absolute win."

Your toothbrush may be more viral than your showerhead

Recent research from Northwestern University discovered distinct viral populations in household bathroom biofilms, with showerheads and toothbrushes harboring different viral communities despite both environments receiving tap water input.²

In their study, 532 viruses associated with 32 bacterial families were analyzed, yet only three bacterial families were noted in both environments (Sphingomonadaceae, Burkholderiaceae, and Caulobacteraceae).

Researchers found that toothbrushes predominantly contained human oral-associated organisms (such as Klebsiella, Streptococcus, and Veillonella), while showerhead environments had common soil and drinking water genera (such as Sphingopyxis, Sphingobium, and Aquabacterium) as well as Mycolicibacterium and Mycobacteroides.²

However, there is currently no evidence of these viruses being virulent or carrying antibiotic resistance genes.²

Upcoming appeal to determine $20 million worth of Medicaid-related lawsuits

ACS State Healthcare and Conduent State Healthcare LLC recently filed an appeal with the Texas Supreme Court to prevent a trial necessitating the defense of its flawed Medicaid prior authorization process-one that approved hundreds of millions of dollars in orthodontic treatment without proper review.³

This case includes three plaintiffs seeking $2 million and an additional ~35 plaintiffs in five different lawsuits seeking over $20 million.

The company stated in its appeal motion: "A decision by this Court will resolve a dispositive issue of subject matter jurisdiction for all the lawsuits and avoid what could otherwise be a tremendous waste of judicial resources."

The state fired Conduent in 2014 from its position as Medicaid administrator after the company mishandled the prior authorization process. After suing for Medicaid fraud, they obtained a $236 million settlement and claimed that they were operating as an agent of the state, and therefore, should not be sued directly under Texas law.³

However, the Supreme Court may decline a hearing of this case; the 3rd Court of Appeals stated that it wasn't clear whether or not the company was acting as an agent of the state.³

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