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You may have heard of the “opioid epidemic” rumbling through our nation, but what does that term mean?
If you’re unfamiliar with this crisis in the United States, it may shock you to learn that dental offices can be starting points for this epidemic.
While opioids in dentistry are definitely useful in many cases (I prescribe them in my own practice!), there are often pitfalls we miss that turn a useful tool to reduce pain into a dangerous addition.
Let’s look at how this works for everyone from the dentist to the patient (and those in between). There is hope for opioid addiction.
What are opioids?
Dentists often prescribe opioids for pain management after surgeries or major procedures. It’s a convenient choice, since opioids are a class of drugs that have pain-blocking qualities. Unfortunately, improperly using these pills can have lasting, devastating consequences.
It’s possible to become addicted to opioids in as little as five days. (1)
Despite this, many dental opioid prescriptions can last for up to 10 days. The severity of this prescription issue makes it important for dentists, dental patients, and their loved ones to learn more. Your knowledge could be the difference between a routine prescription and a painful battle with opioid addiction.
You can stay safe from the opioid epidemic by knowing the risks of using opioids, educating yourself on taking prescribed opioids correctly, and understanding what to do if addiction takes hold.
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List of Opioids Prescribed in Dentistry
The following are opioid drugs often prescribed for pain management by dentists:
- Hydrocodone (Vicodin)—The prescription rate for this drug doubled between 1999 and 2011.
- Oxycodone (Percocet® or OxyContin®)—This prescription rate increased 500% in the same timeframe. (2)
- Acetaminophen with codeine (Tylenol® No. 3 and Tylenol® No. 4).
Opioids also branch beyond prescribed medications. Other forms include heroin, morphine, tramadol, and synthetic opioids like Fentanyl (Duragesic). Though each of these opioids vary in strength, they all have addictive qualities and harmful effects if used long-term.
According to the Centers for Disease Control and Prevention, the U.S. is in the midst of the “worst drug overdose epidemic in history.” (3)
Unfortunately, the data shows that prescription rates for opioids are still climbing. The government, researchers, and dental experts all warn against prescribing unnecessary opioids. Instead, they are urging patients to consider other viable options for pain relief.
What is the opioid epidemic?
The opioid epidemic is caused, in part, by nonmedical use of prescription drugs. This may include: (4)
- Taking a larger prescription than needed
- Using drugs prescribed to someone else
- Taking your prescription with alcohol or other legal or illegal drugs
- Abusing prescription drugs to feel a sense of euphoria—this behavior is much more likely to occur with opioid pain relievers than with other medicines
Due to their addictive nature, these pills are in high demand, and not always for medicinal use. What’s the delineation between necessary and nonmedicinal use? Well, for one, the effect on the user’s life.
The definition of opioid use disorder is a pattern of misuse that leads to emotional or functional distress.
A simple study of third molar extractions reveals how sinister this issue can be. A recent study found that young Americans prescribed opioids for their wisdom teeth were at greater risk for addiction.
Patients who filled their opioid prescription had a 13% chance of persistent opioid use. This puts them at high risk of addiction. On the other hand, only 5% of patients who didn’t fill their prescription struggled with long-term opioid issues. (5)
Statistics like these are why I urge dentists and their patients to consider choosing anti-inflammatory drugs or non-opioid pain relievers. One prescription, especially in younger people, can have long-term effects. Consider several options before jumping immediately to opioid prescribing with addictive potential.
If prescriptions for opioids slow down, this epidemic may as well.
Opioid Abuse Statistics
How many people abuse opioids?
In 2016, the U.S. Department of Health and Human Services (HHS) found that 11.8 million people over the age of 12 misused opioids. 2.3 million had begun the habit within the past year, highlighting the growing epidemic. (6)
Prescription Opioids vs. Heroin
In 2016, 11.5 million Americans misused prescription opioids, a number far greater than the 948,000 who had used heroin. That’s an astronomical difference in users.
Unfortunately, only 17.5% of those addicted to opioid painkillers sought professional help. This totals far less recovery treatment per capita than those fighting a heroin addiction. (7)
Both are issues of drug abuse, but for some reason, opioid drug users aren’t seeking help like they should. Perhaps this is due to the fact opioid addiction affects people who don’t seem like drug abusers, or because the addiction began with a legal prescription. Whatever the reason, the statistics are alarming.
Can prescribed opioids function as a gateway drug?
In a recent interview with heroin users entering treatment, 80% had abused prescription opioids before turning to heroin. (8) These numbers highlight that opioid use is a road that can lead to other harmful narcotics.
Substance abuse is always a real threat. Prescribed opioids present no less inherent danger and can lead to other addictions.
Can prescribed opioids hurt my job performance?
Research has linked an increase in opioid prescriptions to a decrease in the number of people participating in the labor force. Men with less than a bachelor’s degree are the most vulnerable.
Nationwide, the number of men participating in the workforce has significantly decreased, with 44% of the decline attributed to opioid misuse. (9) Simply put, opioid use causes overall employment numbers to drop.
What does prescription opioid misuse cost society?
Opioid addictions have a wider-reaching and more injurious impact than you may think. Opioid misuse cost a staggering $11.8 billion in the U.S in 2011. 53% of these costs came from losses in workplace productivity, and 30% was due to unnecessary cost in our health care systems. 17% of the money went to the criminal justice system to handle cases. (10)
This epidemic impacts taxpayers, patients, public health, members of the workforce, our courts, and more.
How do people get addicted to an opioid?
Most people swept up in the opioid crisis were originally prescribed the pills they now find addictive. That’s why it’s crucial to know the warning signs of nonmedical use and prescription drug addiction.
The first symptom to note is a feeling of dependence. Dependance can manifest in several forms. These include missing the drug when you are no longer taking it or experiencing opioid withdrawal symptoms.
Withdrawal symptoms include restlessness, trouble sleeping, vomiting, and more. If you notice these sensations, contact your doctor immediately. Never continue use of opioids or a prescription when you notice signs of dependence or withdrawal.
Addiction is defined as continued use of a drug despite negative consequences, so avoid it at all costs. (11)
Prescription opioids, while occasionally helpful for severe pain, are also highly chemically addictive. Opioids access opioid receptors in the brain and body. This process leads to relaxation, euphoria, and blocked pain messages.
It also gives the brain a surge of dopamine, a neurotransmitter. This is where the real problem lies. Our brains can become addicted to this rush of dopamine, causing us to crave the opioids that provide it.
You can learn more about the brain’s response to drugs in this video from the National Institute on Drug Abuse.
Short-term and Long-term Effects of Opioids
So, other than addiction, what risks and effects are you facing if you use medical opioids?
Short term use can have fewer side effects, though still potentially unpleasant ones. A few of these pesky problems include constipation, nausea, drowsiness, and slowed breathing.
Furthermore, most states have strict laws against driving under the influence of opiates due to delayed response times in users. Be aware that you may need to make appropriate transportation arrangements to continue life as usual. That is, if your body will let you.
Long-term effects of opioid use are even more concerning. Research suggests harmful side effects increase with length of use. Your organs can suffer due to vomiting, abdominal bloating, and liver damage. Furthermore, your brain may sustain damage or develop chemical dependence.
As you continue, your tolerance will increase, which demands higher, more harmful doses to feel the opioids’ impact. These negative side effects will continue to compound with prolonged use. (12)
Improper use of these prescribed medications can pose some of the same terrors as more infamous substances like heroin! Here’s a visual depiction of what’s going on inside the body when opioid abuse occurs. It’s clear that the less opioids in your system, the less risk of ugly side effects.
Risk Factors for Opioid Addiction
Risk factors for opioid use disorder are complex, but there are a few considerations that could raise your chances of getting hooked.
- Legitimate opioid use before turning 18. Whether a teenager was prescribed opioids for dental work or another pain-related condition, prescribed use during the teenage years drives up the risk of later abuse. Teenagers who use opioids during the later teen years have a 33% higher chance of abusing the drugs as an adult, even if they have no other risk factors for addiction. (13)
- Ignoring directions. Taking opioids instead of opting for other pain relievers will require precision on your part. The federal government has estimated that 21-29% of patients given opioids for chronic pain take them incorrectly. If you receive a prescription for opioids, follow your dentist’s exact directions. Misusing them or treating them casually could build dependence.
- Chronic pain. It seems that chronic pain patients are more likely to develop an addiction than the general population. Up to 60% of major trauma patients are estimated to develop an addictive issue. (14) Due to their pain-blocking nature, opioids can be particularly attractive. If you have chronic pain and your dentist prescribes opioids, proceed with caution.
- A history of addiction. If you’ve experienced past addiction, it can be a potential indicator for opioid use disorder. Talk with your dentist to ensure this addictive pattern won’t repeat with your dental pain medications. (15)
- Mental health conditions. Any struggles with mental illness can make taking opioids more risky, according to the Substance Abuse and Mental Health Services Administration (SAMHSA).
- Personalized effect. Your own physiological reactions to opioids can heighten your risk of addiction. Biological makeup can determine individual experience. Certain people are more or less likely to experience an addictive, dopamine-driven “euphoria.” This feeling is subjective and ranges between patients. (16)
- Education level. Congrats to all you grads out there! The more scholastic achievements you have under your belt, the less likely you are to succumb to an opioid addiction. That’s one more reason to be a lifelong learner! (17)
This list of symptoms can help you and your doctor assess if you are struggling with substance use disorder.
If you begin to experience thoughts of self-harm or are looking for opioid treatment options, do not hesitate to contact the National Suicide Prevention Lifeline. They are always available by call, text, or online chat. Reach out 24/7 at 1-800-273-TALK.
The good news is that you have more treatment options than you may realize. This problem is treatable with time, effort, and intentional steps toward change.
Can you overdose on prescription opioids?
Overdosing on prescription opioids is 100% possible. The problem in abusing these drugs is that you build up tolerance over time. Users seek “higher highs” and bigger doses to feel satiated.
Most opioid deaths are from taking prescriptions in doses much larger than prescribed or ingesting them in combination with other drugs. Both of these choices tend to become dangerous habits in long-term users seeking a fix. (18)
Taking a high dose of opioids can lead to death from cardiac or respiratory arrest.
The danger here? Tolerance. Building a tolerance to opioids from long-term use is treacherous. Tolerance to the drug’s euphoric effect will increase faster than your body’s tolerance to the dangerous side effects.
Users may be taking more to get high, but at some point, their body can’t keep up. In fact, this is the reason that many opioid overdoses are accidental. The need for more dopamine and higher doses can be fatal. Did you know that opioid overdoses actually kill more people than car accidents each year? These tragic accidents can be avoided with addiction treatment.
This is a crucial juncture in history for understanding and preventing overdoses. The opioid epidemic mortality rate is skyrocketing. Overdose deaths in this category have risen 200% since 2000.
In fact, the CDC found that 61% of all drug overdose deaths were linked to an opioid. (19) As it steals over 130 lives each day, this crisis has established itself as a real national threat.
Wondering if you’re in danger of abusing opioids? This quiz can help you and your doctor assess if you need treatment for substance abuse.
If you’re looking for a next step, there are resources available.
- SAMHSA has a directory of opioid treatment programs.
- You might join a meeting of Narcotics Anonymous for support.
- Finally, consider this thorough list of National Institute of Health-approved options to treat opioid addiction.
Most importantly, if you feel you are in danger of an overdose, call 911 right away. Your treatment plan can be determined once you are safe and in stable condition.
How to Prevent Opioid Addiction
Now that we’ve covered the seriousness of this crisis, it’s time for one of my favorite subjects: prevention.
As a family member, dentist, or patient, you’re likely to come into contact with opioids at some juncture. Here are some of my tips to stay safe and use your educated judgment about prescription opioids:
1. For Dentists
As healthcare providers, we are the first line of defense against these chilling statistics. It’s more important each year to stay updated, conscious, and preventative in your care. Here are my top tips for protecting your patients and prescriptions:
- Stay up to date. The NIH is clear that “partnerships between researchers and practitioners are increasingly important as we face crises of the scale of the current opioid overdose epidemic.” Staying current with ADA standards creates a safety net for your practice and provides clear guidelines in this ever-changing area.
- Continue your education. One of my favorite things about medicine is the constant opportunity to access fresh ideas and information. Here’s a joint webinar presentation from the ADA and CDC presenting alternatives to opioid prescriptions. These steps can cut down on addiction rates after dental procedures.
- Avoid generalized prescriptions. Talk to your patients about their individualized needs and the risks of opioids. Each prescription is personal, so ask thoughtful questions and suggest non-opioid pain relievers and anti-inflammatories first. You will communicate how much you care about your patients by your candor.
- Limit the quantity of opioids that you prescribe. Data suggests that likelihood of opioid dependence starts climbing on the third day. (20) Offer as few doses as possible without leaving your patient uncomfortable. Many times, after a few days, a NSAID will handle the pain level.
- Do your homework. Check in with your state prescription database to be sure your patient does not already have an opioid prescription.
- Be observant. Remember, not all patients who are drug-seeking will present with obvious symptoms. (2) Before prescribing opioids, take a few moments to look for more subtle signs of drug-seeking behavior (DSB).
2. For Patients
- Communicate and comply with instructions. Prevent potential pitfalls with prescription opioids by following your doctor’s orders as carefully as possible. Also, please don’t hesitate to let your dentist know if you develop any concerns. If you notice withdrawal symptoms, make your doctor or dentist aware right away. Your dentist is here to help your health, not hurt it. Good communication is key for safe and exceptional results.
- Hands off! It’s common for opioid misuse to start with buying, “borrowing,” or being given someone else’s prescribed medications. Leftover medications around the house can also increase the risk of opioid abuse. Don’t give family, friends, children, or pets a chance to get to your opioids. Dispose of unused medicine quickly and properly, for everyone’s sake. (21)
- Limit your use. Even if your dentist prescribed several days’ worth of opioids, see if you can go without after a day or two. Each day you remain on opioids increases your chance of addiction, so if you can limit your usage, go for it!
- Don’t be afraid to advocate for yourself. Be sure your dentist is fully aware of you and your family’s medical history, especially if it involves addiction. Knowing the circumstances will help your dentist prescribe the best, most personalized option. You have many options for pain management. Don’t feel forced into taking opioid medication! Your health is uniquely yours—if opioids make you uncomfortable, your dentist can assist in finding a better treatment plan for you.
- Ask away. Useful questions could include:
- inquiring about less addictive medicine for pain management,
- asking for an addiction risk assessment, and
- investigating drug interactions between your prescriptions.
Believe it or not, good dentists aren’t bothered by questions. Taking your health seriously and learning your needs is a great step for any patient! The more you know, the more you can feel confident that your dental and overall health is thriving.
3. For Families
- Wisdom tooth wellness plan. As mentioned, teens are likely to be given opioids for wisdom tooth removal. Unfortunately, this practice can intensify the likelihood of continued opioid use. Before your make any medication decisions for this procedure, try reviewing the facts together. You could start with this guide created specifically for teens. Discussing prescription options for oral surgery is a fantastic opportunity. Your conversation now could help your teenager navigate the opioid epidemic in the future.
- Know what you’re dealing with. Do your best to stay informed on all possible drug threats your teen is facing, including opioids. This recent report on drug use among teens is a helpful resource. A bit of good news: there is no significant spike in opioid use disorder in teens until they reach 12th grade.
- Protect the next generation. Pregnant women should know that abusing opioids while expecting is highly dangerous. The decision to misuse prescription opioids can result in your baby experiencing withdrawal symptoms or birth defects. In more severe cases, mothers with opioid use disorder can even lose their child. (22) This list outlines options for a healthier lifestyle and safer baby. Your child and your body are too important to put through opioid addiction!
- Build a support network. IECMH consultants offer support and tools to families that have been affected by opioid misuse. If you or someone in your family is struggling, call 1-800-662-4357 for referrals to nearby programs. You can still receive the help and care you need for your child and family. It’s never too late, and you are not alone.
- Sharing (information) is caring. If you suspect a teen in your family is misusing pain medicine, you can direct them to this guide. Ask their pediatrician for any recommended resources, and offer to talk if they’re ready.
Storing and Disposing of Opioid Medications
Imagine that you were prescribed a week of opioids for a dental surgery.
Being aware of the dangers they can pose, you stopped use by day three. You wanted to control your addiction risk, even if you had more pills. I’d say that’s a great job of prevention! However, even if you don’t finish your opioid prescription, it still poses a significant risk.
“Leftovers” are never safe to keep around your residence. In particular, unused opioids from dental procedures are common targets for drug abusers. (23)
To put an end to non-medical drug use in your home, you cannot leave them lying around. Luckily, patients have many safe options for storing and disposing of opioid medications.
Until you can remove the opioid medication from your home, the best way to store your pills is in a safe place. Choose a space out of sight and beyond children’s reach, ideally in a locked cabinet. The only person who should be able to access those pills is the person responsible for them. Taking this measure prevents future addictions, accidental poisonings, and more.
To say goodbye to your medication, here are a few safe disposal options:
- Medicine take-back sites and events,
- Collection receptacles. (Your local law enforcement agency can direct you to any nearby community receptacles).
- Flushing certain, potentially dangerous medicines in the toilet. For a guide on how to do this safely, click here.
What’s the best time to dispose of your opioids? As soon as possible. The more time that elapses before disposal, the higher the odds of abuse.
Key Takeaways: How to Avoid the Opioid Epidemic
Before you fill your prescription to treat your dental pain, think twice about the highly addictive nature of opioids. The opioid epidemic in the U.S. increases every year. Education, awareness, and prevention can reverse this terrible trend.
There are other choices for pain relief with notably safer side effects. These include options such as ibuprofen, acetaminophen, and aspirin—in some cases, heavy doses of ibuprofen can be better at pain management than narcotics, without the same risk for addiction.
There are also natural ways to decrease pain after dental work, such as warm compresses, CBD oil, and using ice. You may also notice a great improvement just by keeping your head more elevated and swishing with warm salt water.
There is no one clear, perfect strategy, including narcotics, for pain management. Even opioids don’t “cure” pain, they’re just a way to take the edge off during the healing process. So, whether you’re a dentist, patient, or family member, don’t be afraid to discuss options when it comes to pain management!
If you do decide on opioids for dental pain, be sure to limit your intake. Be sure to communicate with your dentist, follow instructions to the letter, and dispose of any unused pills quickly and appropriately. It’s possible to use opioids safely if you are communicative with your dentist and disciplined in your approach.
Lastly, if you or a loved one is struggling with opioid use disorder, know that there is a network of recovery, support and treatment that’s poised to help. You have more resources available than you may know. Informed and empowered, patients and dentists can stop dentistry prescribed opiate abuse and choose safe pain management.Learn More: Know Before You Go: Root Canals
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