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Prescribing in an epidemic: alternatives to dental opioids

In 2019, 49,860 people in the United States died from an overdose involving opioids, according to the National Institute on Drug Abuse. More than 14,000 of those deaths were the direct result of prescriptions for the substance. In fact, the American Journal for Preventative Medicine reports that dentists are responsible for one in 10 of all U.S. opioid prescriptions. Opioid misuse is an epidemic in America. While the substance can be helpful in easing pain due to surgery, injury or illness, its highly addictive nature puts users at risk for addiction, overdose and death.

Luckily, prescriptions opioids such as hydrocodone, codeine, morphine and fentanyl are not the only option to prescribe to your patients dealing with dental pain. Let’s take a look at the risks and, more importantly, the solutions.

The slippery slopes of addiction and recovery

The reward centers of our brains can’t help but love opioids at first: The drug triggers endorphins, diluting feelings of pain and boosting euphoria. Though this effect can be particularly useful in a medical setting, the Centers for Disease Control and Prevention estimates that 136 in the United States die every day from opioid overdoses.

Prescription opioids become more addictive when taken in ways other than prescribed, such as snorting or injection. The road to recovery from opioid abuse is not an easy one. Painful withdrawal symptoms can kick in within hours of an addict’s last dose. Prescribing opioids to a patient in recovery who may not have disclosed their current or past drug abuse is a risk that every medical professional should take into consideration.

Anyone who is taking opioids is at risk of developing addiction, according to the Mayo Clinic. Of course, there are other influences at work that can put a person at higher risk for addiction. These environmental, emotional and genetic factors can all contribute:

  • Socioeconomic status
  • Age
  • Family and personal history of drug abuse
  • Mental health

What to prescribe instead of opioids

As a professional who know how effective prescription opioids can be, it may feel counterintuitive for you to cut a useful resource from your practice. However, as the opioid epidemic soldiers on for yet another decade, the risk versus reward must be taken into account.

For minor aches and pains, The American Society of Anesthesiologists (ASA) recommends basic over-the-counter ibuprofen, acetaminophen, aspirin and steroids. Studies show that nonsteroidal anti-inflammatory drugs (NSAIDs) can be more effective at reducing pain than opioids and The American Dental Association (ADA) offers a helpful chart on prescribing NSAIDs as an alternative to opioids.

  • For mild pain from procedures such as gingivectomies, simple extractions or subgingival restorative work, the ADA recommends 200 to 400 mg of ibuprofen every four to six hours, as needed.
  • For moderate to severe pain from procedures such as implant surgery or surgical extraction, the ADA recommends 400 to 600 mg plus 500 mg of acetaminophen every six hours for 24 hours.
  • When it comes to chronic pain, some anti-seizure medications work on the same neurotransmitters as pain, according to the University of Southern California (USC). USC also recommends muscle relaxants and local anesthetics as alternatives to opioids.

What you can do now

Despite the three decades that Americans have spent in an opioid crisis, there is much work still to be done. One of the easiest first steps that you can take is simply limiting prescriptions to opioids and taking the time to research safer recommendations for your patients. For more resources on addiction, visit the Substance Abuse and Mental Health Services Administration website.

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