Synthetic Narcotics Abuse
Should Synthetic Narcotics be Routinely Prescribed for Dental Treatment? What about Abuse?
Synthetic narcotics abuse as well as other drugs has resulted in drug overdose becoming the number one cause of non-medical deaths. There are approximately 15 deaths by drug abuse and overdose per year per 100,000 people. This is totally unacceptable and is caused by the abuse of prescription drugs such as synthetic narcotics prescribed by physicians and dentists. Often the patient, who has become dependent upon such drugs, obtains prescriptions from multiple dentists or physicians and this obviously compounds the problems. That may mean that they are actually selling them to others.
In the dental profession, especially with older teenagers, several million per year have their wisdom teeth removed. It is part of “growing up” and is a necessary treatment in about 82% of the young adults. Often they may be given a prescription for a synthetic narcotic for as long as a month. This is not necessary. Perhaps one the night before and 3-4 the day after will suffice in most cases. On rare occasions, a small number more may be required. Subsequent relief from discomfort should come from NSAIDS (Non-Steroidal Anti Inflammatory Drugs). This step alone will limit synthetic narcotics abuse. NSAID’s are over-the-counter medications such as Aleve, Motrin, Ibuprofen, Napraxen, Tylenol, etc. and will suffice in the majority of cases. Never should a teenage patient for any length of time be kept on synthetic narcotics (most popular is hydrocodone and oxycodone.) That way there is no chance of synthetic narcotic abuse or addiction. All primary care providers, physicians, and dentists should evaluate their prescribing of synthetic narcotics. No care-giver wants their patient to experience pain, and the purpose of the synthetic narcotic is to prevent the same. There is absolutely nothing wrong with alleviating the pain, but minor post operative discomfort often does not require such strong medication, and that is when over-the-counter NSAIDS do wonders. The fortunate situation is that 95 to almost 100% of the prescriptions written by dentists are non-refillable, but the unfortunate thing is that almost 90% are for hydrocodone of oxycodone in combination with other drugs.
Physicians and dentists, and any other prescription provider, should re-evaluate the above information and recognize that opioids used for analgesia should be carefully monitored, especially on younger patients. NSAIDS have proven to be quite effective in relieving post operative pain. Synthetic narcotics are also effective but have the potential to be abused and may also have unsavory effects.
Pain management can be achieved successfully by the utilization of smaller doses and with consideration for the use of NSAIDS.
Life Member of American Dental Association, Emeritus Fellow of Academy of General Dentistry, American Association of Implant Dentistry.