Jessamin E. Cipollina, M.A.
The current opioid epidemic in the U.S. is heartbreaking. Recent statistics tell a harrowing story of opioid addiction. In 2016, 11 million Americans reported abusing prescription opioids, with an estimated 1,000 people being treated for opioid misuse every day.1 The opioid overdose death rate is even more shocking; in 2016, nearly 64,000 people died from opioid overdoses, and over 40% of these deaths involved a prescription opioid.2 A recent report from DrBicuspid shows that people are more likely to die from an accidental overdose than from a car crash as of 2016. This puts opioid overdoses in second place on the list of causes of unintentional and preventable death – suicide is number one.2
Opioids are prescribed for a number of complaints, namely post-surgery relief and chronic illnesses. Recent research shows that dentists are responsible for 12% of opioid prescriptions, and two-thirds of these prescriptions are for oral surgery.3,4 It is also important to consider what happens beyond the prescription – unused opioids from dental procedures cause approximately 1,500 deaths each year.3 Many health organizations are calling on physicians, nurse practitioners, physician assistants, dentists and oral surgeons to evaluate pain management more closely and take on a more conservative approach to prescribing potentially harmful and addictive pain relief medications.
Opioid addiction is a major public health concern in the U.S. that has garnered an overwhelming amount of attention from government organizations, media outlets and healthcare agencies. As a result, there has been an influx of research studies examining the overall impact of opioid use and abuse, including reports on prescribing practices and the increase of addiction among teens.5
For example, a recent study found that teens given prescription painkillers after dental procedures were 10 times more likely to be diagnosed with opioid abuse than teens who had not received a prescription.6 Another report found that between 2010 and 2015, the number of dental opioid prescriptions for adolescents per year had increased dramatically from 99.7 per 1000 patients to 165.9 per 1000 patients.7 Even after prescriptions run out, addicted teens may find ways to buy prescription or illegal opioids elsewhere, leading to overdose and even death.8 These growing numbers of opioid prescriptions and adolescents’ evident vulnerability to addiction demonstrate how dentists need to seek alternatives to opioid painkillers for dental procedures.
Health professionals and organizations are actively promoting the use of Tylenol and Advil as a pain management alternative that proves to be just as effective as opioids.5,7-11 Reducing the number of prescriptions for routine dental procedures can greatly reduce the risk and instance of opioid addiction and abuse, further reducing the amount very preventable opioid-related deaths.
Dentists and other health professionals can play a significant role in curbing high rates of opioid addiction and overdose by limiting opioid prescriptions, especially for younger patients, and using alternative pain management regimens. Many health professionals agree that acetaminophen and ibuprofen are equally effective in managing pain as opioids, and do not come with the risk of addiction.9-11 Dentists can also limit the amount of opioids they prescribe. The CDC recommends prescribing three days worth of medications at fewer than 50 morphine milligram equivalents per day.1 This prevents patients, their family or friends from misusing leftover pills – any leftover pills should be returned to the pharmacy or disposed of properly, either by returning them to the pharmacy or mixing them with water and an unpalatable substance (cat litter, used coffee grounds, etc.) before being thrown away.9,10
While opioid overdoses have increased significantly over the past several years, a recent study revealed that between 2012 and 2017, new prescriptions for opioids, meaning those that receive an opioid prescription for the first time, dropped by half, along with a significant decrease in the number of physicians prescribing first-time opioids. Although the numbers had decreased, the dose and length of prescriptions remained in excess of the CDC recommendations.12 This represents an overall lack of attention to patients who receive opioids for short-term care, such as post-op pain management – similar to what dentists would prescribe after such procedures as wisdom teeth removal.
New prescriptions by dentists and other health professionals need to be the larger focus of the current opioid epidemic, since these prescriptions readily available for misuse, and lead to abuse if leftover medications are kept in the household and taken by others after the patient no longer needs them. Policies around opioid prescriptions, namely for teens and first-time users, need to be strengthened; awareness around non-opioid pain management needs to be investigated and promoted. Dentists and other health professionals are in a prime position to help reduce this national crisis by more closely evaluating patient needs and pain management tools that are potentially less harmful.
1Centers for Disease Control and Prevention. Opioid overdose: understanding the epidemic. CDC. Updated December 19, 2018. Retrieved from: https://www.cdc.gov/drugoverdose/epidemic/index.html
2Pablos T. Opioid overdoses eclipse car crashes for accidental deaths. DrBicuspid. Published January 25, 2019. Retrieved from: https://www.drbicuspid.com/index.aspx?sec=log&URL=https%3a%2f%2fwww.drbicuspid.com%2findex.aspx%3fsec%3dsup%26sub%3dapm%26pag%3ddis%26ItemID%3d324123
3Janakiran C, Chalmers NI, Fontelo P, et al. Sex and race or ethnicity disparities in opioid prescriptions for dental diagnoses among patients receiving Medicaid. J Am Dent Assoc 2018;149(4):246-255. DOI: 10.1016/j.adaj.2018.02.010
4Moore PA, Ziegler KM, Lipman RD, et al. Benefits and harms associated with analgesic medications used in the management of acute dental pain: an overview of systematic reviews. J Am Dent Assoc 2018;149(4):256-265.e3. DOI: 10.1016/j.adaj.2018.02.012
5Dana R, Azarpazhooh A, Laghapour N, Okunseri C. Role of dentists in prescribing opioid analgesics and antibiotics: an overview. Dent Clin North Am 2018;62:279-294. DOI: 10.1016/j.cden.2017.11.007
6Schroeder AR, Dehghan M, Newman TB. Association of opioid prescriptions from dental clinicians for US adolescents and young adults with subsequent opioid use and abuse. JAMA Intern Med 2019;179(2):145-152. DOI: 10.1001/jamainternmed.2018.5419
7Gupta N, Vujicic M, Blatz A. Opioid prescribing practices from 2010 through 2015 among dentists in the United States: what do claims data tell us? J Am Dent Assoc 2018;149(4):237-245.e6. DOI: 10.1016/j.adaj.2018.01.005
8Marso A. Teens get addicted to opioids after wisdom teeth removal. Insurers are cracking down. Personal Liberty. Published March 6, 2019. Retrieved from: https://personalliberty.com/teens-get-addicted-to-opioids-after-wisdom-teeth-removal-insurers-are-cracking-down/
9Garrity M. Dental health plays significant role in opioid epidemic. Becker’s Dental and DSO Review. Published February 25, 2019. Retrieved from: https://www.beckersdental.com/dentists/34391-dental-health-plays-significant-role-in-opioid-epidemic.html
10Biuso T. The impact of the opioid epidemic on oral health. AZ Big Media. Published February 11, 2019. Retrieved from: https://azbigmedia.com/the-impact-of-the-opioid-epidemic-on-oral-health/
11Cohen R. Unwise and unnecessary: opioids for wisdom teeth extractions. The Washington Post. Published March 3, 2019. Retrieved from: https://www.washingtonpost.com/national/health-science/unwise-and-unnecessary-opioids-for-wisdom-teeth-extractions/2019/03/01/f3600a3c-2e33-11e9-86ab-5d02109aeb01_story.html?noredirect=on&utm_term=.cd675dca4adc
12Park A. Doctors are writing half as many new opioid prescriptions as they used to, study says. Time. Published March 13, 2019. Retrieved from: http://time.com/5550686/opioid-prescribing-patterns-drop/