Fatal Attractions: Opioids and Dentistry

According to the Centers for Disease Control and Prevention (CDC), 130 Americans die each day from opioid overdose. And the number of overdose deaths attributed to opioids in 2017 was six times higher than in 1999.¹

As the United States opioid use continues its upward trajectory into what many describe as a national public health crisis, dentists are among the professionals most likely to be on the front lines. The American Dental Association (ADA) and other organizations are shifting into high gear to help clinicians put the brakes on this mounting catastrophe.

The Dental Connection

So where do dentists fit into this grim scenario? Quite simply, dentists prescribe opioids following dental-related surgical procedures — also for nonsurgical dental visits as well. A recent study published in the Journal of the American Dental Association, reports that the number of opioid prescriptions written by dentists per 1,000 dental visits, for patients under age 65, increased from 130.58 in 2010 to 147.44 in 2015, representing a 12.9% increase overall. But this increase was monumentally larger in the 11-18 year age group, at 66.4%.²

For patients ages 11-18, for whom wisdom teeth extraction has practically become a right of passage, this is likely their first exposure to narcotics. In fact, prescriptions written in the wake of such extractions are reportedly a primary reason for the increase.²

Used as a post-operative chaser, an opioid is very good at managing pain. But, all too often, young patients have been given more pain pills than they actually need. There is evidence that over half of opioid prescriptions end up not being needed, and instead are used by friends and family. For this reason, dentists must walk a fine line between underprescribing and overprescribing.

While the medical profession is more likely to treat chronic pain with long-acting, slow-release opioids such as OxyContin, acute pain is more the purview of dentists, who tend to prescribe more short-acting, immediate-release opioids, like Vicodin, Norco, or Percocet. But the real issue for dentistry where opioids are concerned has more to do with the age of the patients they are being prescribed to.

Kids are more apt to be risk takers. Put that together with the fact that their brains’ pleasure and judgment centers are not yet fully formed, and the reality that this is probably their first experience with serious drugs, and you’ve got a potentially explosive situation.

Yet, according to one source, dentists still write about 31% of opioid prescriptions for patients between the ages of 10 and 19. And approximately 56 million 5 mg tablets of hydrocodone are prescribed after third-molar extractions in the US annually.³

Solutions

The ADA’s 2018 interim policy on opioids in the treatment of dental pain recommends a number of strategies for dentists to consider to safely manage dental pain, including:

• Mandatory continuing education on prescribing opioids and other controlled substances.
• Prescribing limits on opioid dosage and duration of no more than seven days for the treatment of acute pain, consistent with the CDC’s evidence-based guidelines.
• Dentists registering with and utilizing prescription drug monitoring programs to promote the appropriate use of opioids and deter misuse and abuse.

In lieu of prescribing narcotics, it’s been found that two or three ibuprofens, in combination with acetaminophen, has been shown to be more effective than Percocet and Vicodin. Between that, the above strategies, expanding on the issue in dental schools and having parents sign consent forms, perhaps dentists will discover the antidote to the fatal attraction of opioids.⁴

For more information, visit ADA.org

REFERENCES

1. CDC. Understanding the epidemic. Available at: https://www.cdc.gov/drugoverdose/epidemic/index.html. Accessed May 6, 2019.
2. Gupta 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: 237–245e6.
3. Bree R, Washington State Agency Medical Directors’ Group. Dental Guideline on Prescribing Opioids for Acute Pain Management. Available at: http://www.breecollaborative.org/wp-content/uploads/Dental-Opioid-Recommendations-Final-2017.pdf.Accessed May 6, 2019.
4. Garvin J. ADA adopts interim opioid policy. ADA News. 2018. Available at: https://www.ada.org/en/publications/ada-news/2018-archive/march/ada-adopts-interim-opioids-policy. Accessed May 6, 2019.