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New study targets dentists for overprescribing opioids
It’s rare to find a person these days who hasn’t had to have at least one tooth extracted by a dentist.
Although bad teeth eaten away by decay are rare these days, 85 percent of Americans have their wisdom teeth surgically extracted by dentists all over the world – millions of them every year.
And the chances are high that every one of those patients was prescribed a dangerously addictive opioid painkiller, like hydrocodone or oxycodone, by their dentist.
No one wants to experience the throbbing pain that can follow a tooth extraction. Pain pills are pretty much a necessity.
But according to a new study from Harvard University, published in the Journal of the American Medical Association, dentists are prescribing too many pain pills after tooth extractions, and the pills they are prescribing are too strong.
“The reason a lot of people go to the dentist is because they have pain or they undergo a procedure that causes some pain, to which the dentists are responding,” said study co-author Brian Bateman, MD, in an article in Pain Medicine News. “But I believe we have gotten away from thinking about opioids as dangerous medications.”
Opioids should be only for truly severe pain
Dr. Bateman, an associate professor of anesthesia at Harvard Medical School, said that dentists “may not be as conservative as they need to be” about prescribing opioids. He said dentists should reserve such medication “only for patients with truly severe pain for which other treatment approaches are not adequate.”
The study found that half of all dental opioid prescriptions exceed 24 tablets of 5 mg of hydrocodone, and that more than 60 percent of adolescent dental patients filled prescriptions for opioids.
Prescribing two dozen or more pills is at least a week’s supply of opioids – too long for most cases, Dr. Bateman cautioned. A better option is a few opioid pills to get through the first day. After that, patients should be transitioned to nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil) or naproxen (Aleve), or to acetaminophen type pain relievers like Tylenol.
U.S. study echoes Canadian study from two years ago
This U.S. study is almost identical to a Canadian study published two years ago. A Novus newsletter at that time described how Canadian dentists were found to be a major source of opioid addiction, prescribing as many as 40 percent of all opioid painkillers prescribed.
In that same newsletter, Novus reported that another Canadian study found prescription opioid overdoses responsible for one in every eight deaths among young adults between 25 and 34. The study authors said there is a “dental connection” between dentists and the soaring rate of opioid overdose deaths.
Back here in the U.S., Dr. Bateman advised that when opioids are considered appropriate, they should be prescribed “at the lowest dose possible and for the shortest duration.”
“Certainly when medications are prescribed in excess of what patients actually need, it creates leftover pills, which we know is a major source for opioids that are misused or diverted,” he said. Both dentists and physicians in general “need to reevaluate the indications for prescribing opioids.”
If you have a teenager or young adult in the house who may be headed for dental surgery, take this information to heart and make the risks well known to both the young patient and the dentist. And if someone you care for needs help with substance use, don’t hesitate – call Novus today.
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