The National Problem of Opioids and Addiction

Opioids have become a national health problem. In 2014, more Americans died from drug overdoses than any year on record — in fact, more died from overdoses than from motor vehicle accidents. According to the U.S. Centers for Disease Control and Prevention (CDC), 44 people die every day in this country due to an overdose of prescription painkillers.

Oxycodone and hydrocodone are involved in more overdose deaths than any other opioids. These highly addictive drugs can create a physical dependence that is a normal adaptation to chronic exposure. The more drugs you take, the more it takes to reach an effective dose. If used as prescribed, short-term use of these medications rarely leads to addiction. Even so, if taken in combination with other substances that can depress the central nervous system — such as alcohol, antihistamines, barbiturates or benzodiazepines — opioid use can lead to life-threatening respiratory depression.

The National Survey on Drug Use and Health reports that 51% of those who misuse prescription painkillers got them from a friend or relative, while only 21% got them from a physician or dentist. The survey also found that 4.3 million Americans engaged in the nonmedical use of prescription painkillers, and that 1.9 million Americans met the criteria for prescription painkiller use disorder.

If taken in combination with other substances that can depress the central nervous system … opioid use can lead to life-threatening respiratory depression

According to the CDC, we have seen a 200% increase in overdose deaths involving opioids since 2000. This problem was recently highlighted at the National Governor’s Association meeting. Vermont Gov. Peter Shumlin notes that opioids “are like candy in America” (New York Times, February 22, 2016). Along with other governors, Shumlin suggests new regulations; among these are limiting the number of opioid prescriptions that each practitioner can write.

Insurance companies are also weighing in. Blue Cross Blue Shield of Massachusetts now requires prior authorization for certain opioid prescriptions. It also requires some patients to use a single pharmacy for these scripts. This approach has reportedly reduced the use of Vicodin and Perocet by 25%, and Oxycontin by 50%.

Dental providers have contributed to the opioid problem. Dental treatment is perceived by many patients as painful, setting the stage for anticipated discomfort. Dentists are aware of this perception, and, obviously, do not want patients to be in pain. As a result, some clinicians prescribe unwarranted pain medications — and sometimes prescribe stronger drugs than indicated.

What can our profession do to reduce the need for opioids following dental procedures? First, we should use the most minimally invasive procedures possible. Second, we should provide appropriate postoperative instructions, including reduction in activity, ice packs and similar, nondrug approaches. Third, if medication is indicated, dentists should consider a combination of nonopioid medications. In many cases, if no contraindications exist, a combination of acetaminophen and ibuprofen has been found to be as effective as hydrocodone for pain relief.

In order to combat what has been described as the epidemic of opioid abuse, dentists need to stop contributing to the problem and, instead, seek to be part of the solution.