Over the past couple of years we as dentists have been bombarded by news about the Opioid crisis in the United States.Not a week goes by where the American Dental Association (ADA) does not send out an email, magazine article or newsletter that mentions this important issue in healthcare. Recently, the House of Representatives were set to vote on more than 20 Bills to combat opioid addiction.
A simple explanation of the issue: Over prescription of opioid containing pain medication can lead to abuse. Abuse leads to addiction and worse case death. This can happen by prescribing opioid pain medication in unnecessary situations or over prescribing so that unused opioids sit around our medicine cabinets within easy reach for someone else to abuse.
A common addiction story starts with the use of prescription opioid pain pills whether prescribed to the abuser or not. If abused, these opioids cause a physical response in the human body that cause one to crave more of the drug. Soon the acquisition of more prescription opioid pills becomes too expensive or simply not available. By this time a person ‘s brain chemistry has been severely altered and they commonly turn to the easiest, cheapest way to get the high they crave. This high is commonly found in the stronger, cheaper and more dangerous street drugs like Heroine. Much of the illegal heroine found on the streets is laced with even more potent narcotics such as Fentanyl, which are often found in the blood streams of those who have overdosed.
Think this is uncommon? Think again, start asking around your family and friends and it won’t be long before you find someone who has been closely effected by a situation similar to the one above. Recent Studies found by the ADA have reported that ER visits for Opioid overdoses are on the rise throughout the country, and have increased by as much as 30% in the U.S. (ADA, Morning Huddle 3/8/2018). Often times the population most at risk for abusing opioid medications are our youth. A recent TIME article (6/2 Ducharme) sited an alarming statistic in which it was found that Opioids were Responsible for 1 in 5 Deaths Among Young Adults.
So if not Opioids, then what?
If you have had a toothache or if I have extracted a tooth for you here at Drewyer Dentistry you may have noticed that I have not sent you home with a prescription for an opioid. Instead I have advised taking a Non-steroidal Anti-Inflammatory, such as Ibuprofen (Advil) and if needed to combine with an Extra Strength Tylenol (Acetaminophen). This advisory of pain medication is usually accompanied by my explanation that research shows this is the best cocktail for tooth related pain.
Here is a broad guideline for treating Dental Pain:
Start with 2 tablets of 200 mg Ibuprofen. If you are not feeling better after 4 hours take 3x 200mg Ibuprofen.
If after 6 hours you are still not feeling better take a combination of 1 Extra Strength Tylenol and 3x 200mg Ibuprofen.
After 6 more hours this recipe can be increased to 1 Extra Strength Tylenol combined with 4x 200 mg Ibuprofen every 6-8 hours.
Keep in mind that this is a general guideline for dental pain and that consulting with us is always best. I generally individualize this regimen depending on our patient’s specific needs. Not only does this pain regimen avoid the use of opioid containing pain medications, but it is backed by strong research. A recent New York Times article (4/25 Bakalar, Subscription Publication) reviewed multiple studies of medications that showed “over the counter pain pills are safer and more effective than prescription opioids for controlling the pain following dental procedures.” A Case Western Reserve University study reported that “Opioids are not the most effective way to manage dental pain” and the Journal of the American Dental Association found that a combination of ibuprofen and acetaminophen (Tylenol) provides more effective pain relief. The American Dental Association’s President Joseph P. Crowley has advised “that over-the-counter products are as effective or more effective than opioids to solve acute pain.”
So, Dr. Austin here asking you to please help me in the effort to protect our community from the dangers of opioids.
Patients: here’s what you can do:
-Dispose of all unused prescription medications. Find a local Drug Turn in Program, flush prescriptions down the toilet or
throw away in the trash. Check out www.fda.gov/drugs.
- Next time you are given a prescription for pain medication, ask if there are any alternative pain control options besides opioids.
Often times Doctors feel forced to prescribe opioids because that is what the public expects. As described above they are not
-Ask about side effects or dangers of the prescriptions you are given.
My Colleagues in Healthcare:
- Consider starting with Over-the-Counter Pain measures before utilizing opioids
for pain management.
-When necessary to use opioids, consider writing for 3 days or less.
-Register with and utilize Prescription Drug Monitoring Programs (PDMPs).
-Educate patients on the dangers and side effects when prescribing opioids.
-Screen patients for abusive characteristics prior to prescribing.