Opioid/Narcotic Abuse and how it Effects the Practice of Dentistry.

     Opioid abuse has become an epidemic in the United States.  In the past 15 years the nation’s opioid epidemic has claimed more than 250,000 lives.  This includes Illegal drugs such as heroin and prescription drugs such as morphine, Percocet and Vicodin.  We also consider this class of drugs also to be synonymous with narcotics. We as dentists often prescribe opioid pain killers.  This is usually in the form of Vicodin or its generic form of Hydrocodone with Acetaminophen.  Some dental practitioners prefer Vicoprofen which has Ibuprofen instead of acetaminophen.

     I was taught in dental school to only prescribe opioids for short term pain relief.  Also, I recommend non-steroidal anti-inflammatories such as ibuprofen and Aleve as a first line of defense for pain.  Starting right away before the numbness wears off and taking the pain medicine before leaving the office. I tell people that most of your pain and swelling does not occur right away but 36 to 48 hours after the procedure.  So start taking the first line pain medicines for the first two days before you get the pain.  This will hopefully prevent inflammation and swelling so you may not even need something stronger like Vicodin. We were also taught in dental school to only prescribe medications such as Vicodin for 3 days duration or less because if you still have pain for more than 3 days something else is probably going on and you need to see us and be reevaluated for example you may have a dry socket or a boney spicule that needs removal following an extraction.  We can always prescribe you another three days worth of pain medicine.

     The government is trying to help all providers identify patients that may be abusers.  Each state have set up their own prescription drug monitoring program that all providers and pharmacies have access to help identify potential abusers.

      Another recent change that helps providers is making certain prescription only in written form.  We can no longer phone in Vicodin.  You have to be seen in the office and get a written prescription.  This has helped many dentists sleep better at night if nothing else, since we don’t get calls in the middle of the night requesting pain meds until they can be seen the next day and then they somtimes don’t show up questioning if they had legitimate pain!

      I hope you gained some insight into how we treat patients for pain.  Remember prevention beats a pound of cure!  Hopefully Nonsteroidals like ibuprofen, ice therapy and rest can help keep our dependence on opioid meds to a minimum in the dental office.