America’s opioid epidemic has killed more than 180,000 since 2000. Many of the victims became addicted after doctors prescribed drugs like Oxycontin and Percocet for them. These prescriptions, however, were likely not their first exposure to powerful painkillers.
According to the New York Times, most opioid prescriptions for people ages ten to nineteen are written by dentists and oral surgeons. This is largely due to the longstanding tradition of prescribing opioids after wisdom tooth removal, which is performed on millions of patients under the age of 25 every year. Almost every single patient who undergoes this procedure is prescribed opioids.
Research has proven that high school kids who are prescribed opioids are one-third more likely to abuse the drugs in the future.
“They don’t develop their addiction from that experience,” says psychiatrist and addiction specialist Dr. Andrew Kolodny. “But because of it, they’re no longer afraid of the drug and they like the effect. They’re getting their first taste of the drug from a doctor or dentist, and that increases the likelihood they would use it recreationally.”
Reducing Opioid Addiction
The first step towards reducing opioid addiction is prescribing “more cautiously,” according to Dr. Kolodny. An increasing amount of oral health professionals are heeding this advice by breaking the habit of automatically prescribing opioids after surgery.
Leading this initiative is Dr. Harold Tu, director of the division of oral and maxillofacial surgery at the University of Minnesota School of Dentistry. Last year, he successfully lobbied the school to implement a new, mandatory protocol that teaches students not to immediately turn to opioids when providing pain medication to clinical patients.
The first-line treatment now consists of non-steroidal, anti-inflammatory drugs like ibuprofen (or NSAIDs) and acetaminophen. Opioids are only prescribed if the patient is allergic to one of these two ingredients or is not experiencing sufficient pain relief.
So far, Tu told the Times, “we have not seen an increase in patient complaints or patients returning saying ‘the NSAIDs are not working; I need something stronger’.”
Equal or Better Relief with Ibuprofen Combined with Acetaminophen
The notion that ibuprofen combined with acetaminophen could ever treat pain as effectively as opioids might seem a bit farfetched until you consult a 2013 study that found the former treatment provides equal or better relief than the latter.*
Dr. Tu’s department is currently compiling results of the new protocol that will eventually be formally presented.
Minneapolis oral surgeon Dr. Angie Rake used to give young patients “10 to 15 Vicodin” only to hear their parents’ ask for more. She has since reduced her opioid prescriptions by about 60%, and now makes an effort to speak to parents about addiction. “Now I have parents thanking me for taking time to educate them,” Dr. Rake said. “And a lot of times they say, ‘We’re really going to try to avoid these.’ ”
Now I have parents thanking me for taking time to educate them. And a lot of times they say, ‘We’re really going to try to avoid these.’
Dr. Rake is a firm follower of Dr. Tu along with Dr. Douglas Fain, president of the American Association of Oral and Maxillofacial Surgeons. He recently conducted a survey that found that half of his members have reduced opioid prescriptions, suggesting they now prescribe just three to four days’ worth of the drugs.
In addition to the number of prescriptions written, Dr. Fain has reduced dosage levels at his Oletha, Kansas practice in an apparent attempt to show patients that opioids should not be taken lightly. “They’re here if you need them,” he says, but only for those in unbearable pain, and even they shouldn’t be given more than a few pills.
*Article Citation: JADA, Combining ibuprofen and acetaminophen for acute pain management after third-molar extractions, August 2013Volume 144, Issue 8, Pages 898–908.