Prescription opioid abuse is a growing, troubling and deadly problem in the United States. Now it seems that even dentists may be playing a significant role in perpetuating the epidemic.
A recent study in the Journal of the American Medical Association reveals that dentists are among the leading prescribers of opioid analgesics. According to the conducted surveys, dental practitioners are often prescribing opioids after tooth extractions, one of the most common of dental procedures. However, they are often doing so without having any evidence that a combination of nonsteroidal medications and acetaminophen is any more effective for post-extraction pain than other means.
In other words, opioid painkillers prescribed by dentists for something as routine as removing wisdom teeth or pulling a tooth are often unnecessary as over-the-counter medications may actually be just as sufficient in managing the pain. With over five million Americans getting their wisdom teeth pulled each year, this poses a very legitimate reason for concern.
The first sign of this unexpected source of opioid prescriptions was discovered in 2011. At that time a survey was taken of members from the American Dental Association Survey Center and the findings were startling. The data shows the following:
- 85% of dental surgeons said they almost always prescribed an opioid
- 64% of surgeons said that their opioid prescription of choice was hydrocodone with acetaminophen
- The average number of hydrocodone with acetaminophen was 20 tablets
- In 96% of the cases, the only medical instructions provided for taking the pills was "as needed for pain”
Additionally, there are countless documented stories of adults and young teenagers receiving dental operations and being prescribed Percocet (oxycodone), hydrocodone and other addictive drugs, even when acetaminophen would be adequate to deal with the pain levels. All of this is taking place in excess. As one expert says, “As many as half of all dental patients could get effective relief from an over-the-counter pain medicine like ibuprofen or acetaminophen.”
Even more, some individuals who become addicted to the prescription opioids from their dental practitioner apparently begin their downward spiral by complaining to their dentist of long-term pain and as a result, received additional narcotics. And since the majority of oral surgeries do not require in-office follow-up visits, patients may take the painkillers beyond the time they feel actual pain simply to experience a feeling of getting high.
Perhaps the most revealing aspect of the JAMA study was when scientists found that the “highest number of opioid painkiller prescriptions were for teenagers, aged 14 to 17 years old, closely followed by young adults 18 to 24 years.” As this time is such an impressionable age, there is an even more increased chance for overuse and ongoing dependency.
Now that data has validated that dentists are among the leading prescribers of opioids, national organizations have also expressed their concerns. The Journal of the American Dental Association (JADA) has advised their members that dentists “cannot assume that their prescribing of opioids does not affect the opioid abuse problem in the United States.” Furthermore, it states: “The misuse and abuse of opioid pain relievers...has reached epidemic proportions. As prescribers of these essential pain relievers, dentists are well positioned to help keep these drugs from becoming a source of harm.”
Instead, the ADA recommends a multi-faceted approach to this increasing problem in dentistry that includes the following:
- continued education about the appropriate use of opioid pain medications
- awareness of the responsibility for ensuring that prescription pain medications are available to the patients who need them
- preventing these drugs from becoming a source of harm or abuse
- understanding the special issues in pain management for patients already opiate dependent.
While in today’s society medical professionals are under an immense amount of pressure to act immediately when a patient complains of pain, regardless of age, there is an obvious problem that is persisting which produces an enormous amount of opioid medication in the hands of patients with much too easy access.
Though there is still much to be done in alleviating this national issue, every little bit counts. It should not be forgotten that, first and foremost, awareness—from patients and parents to dentists and dental surgeons—is crucial in assuring that prescription opioids for dental work are used appropriately.