The opiate addiction epidemic has become big news lately. It is a very real problem that has touched the lives of tens of thousands of people across the country. Almost everyone knows someone–either a close relative, friend or acquaintance–who has struggled with opiate or heroin addiction. All too often it has led to overdose and death.
Many times, that addiction started with a simple prescription to control or manage pain after a surgical procedure, sports injury or other event. So do the dentists of this nation hold some responsibility in this problem? That’s a tough question. As a potential prescriber of controlled pain medication–Percocet, Vicodin, Percodan, Tylenol #3 and so on–I know there is a possibility that the patient could abuse these medications if they are not used as directed. The problem lies in the abuse and improper use of properly prescribed drugs. I personally have been asked to prescribe drugs when I knew it was not appropriate. Having a healthy relationship with your patients makes it easy to determine what is best.
Synthetic opiates–oxycodone and hydrocodone–can be habit-forming. It is when a patient is prescribed large volumes of these medications with possible refill options that the problems start. A large number of tablets prescribed at one time would be more than 20, in my opinion. The possible scenario goes like this. A patient has a knee injury. They recover from the injury, but continue taking the pain medication long after the injury heals. Now they are hooked. They cannot get any more tablets, so they go to the next best thing: street heroin. You know how this goes!
So where does dentistry fit in with this problem? We have taught–and I teach to my residents–that NO ONE needs a prescription for more than 12 tablets of a controlled substance in a dental scenario. More importantly, there are very reliable and adequate substitutes for controlled medications such as Vicodin, Percocet, Percodan and Tylenol #3. One substitute is a combination of ibuprofen (Advil) and acetaminophen (Tylenol) taken simultaneously (400 mg of ibuprofen and 300 mg of acetaminophen). A published article by Dr. Elliot Hersh, of the University of Pennsylvania School of Dental Medicine, showed in a double blind controlled study that this combination of ibuprofen and acetaminophen was as effective as opioid combinations following third molar (wisdom teeth) surgical extractions (source: The Journal of the American Dental Association, Vol. 144, Issue 8, August 2013, pp. 898-908).
The dental community has been aware of the acute problem of opioid addiction for many years, and has been at the forefront of helping to prevent these potential tragedies. We want to be part of the solution, not the problem. If you know of someone with an opioid problem, please call my office. I can connect you with caring, confidential help. It is never too late.