Impact of Opioids in Dentistry

In the opioid epidemic, dentists play an important role that can affect change. Prescribing opioids is far too easy, and dentists are among the leading opioid prescribers. A dentist would often prescribe them as a “just in case medication,” so the patient doesn’t call over the weekend or after hours. However, this is commonly practiced without consideration of the severity of consequences.

Opioids are used in different health care environments to address acute pain. Prescribing opioids to treat pain contributes to the opioid crisis, which has grown to become a public health issue. In dentistry, drugs used for pain relief that require a prescription from a dentist include morphine, oxycodone, codeine, and hydrocodone.

Opioids as a Public Health Issue

According to the 2016 NSDUH (National Survey on Drug Abuse and Health), more than 3 million people (older than 12) and about 240,000 adolescents (12-17) abused prescription pain relievers. The most frequent prescribers of these substances – dentists, primary care physicians, and internal medicine physicians – must have the resources and tools required to detect and address any addiction issues with their patients.

As dentists prescribe more opioids to adolescents, they have an increased responsibility to affect the pipeline of opioid abuse. We cannot understate the importance of knowing how to detect, handle, refer, and treat those with opioid use disorder.

How to Identify an Opioid Addict

The critical first step in identifying a chronic opioid user is an accurate and detailed psychosocial and medical history. Dentists must ask about recent drug or alcohol use before prescribing opioids. A medical history of illicit drug, alcohol, and medication use will provide clues that suggest a patient’s substance abuse habits. Also, risk factors for opioid misuse include mental health problems, family history of substance use disorder, criminal history, and age less than 45 years. The most common characteristics of people with drug use disorders include:

• Drug-seeking behavior
• Escalating use – increasing dose or frequency to treat the patient’s pain
• Lying to obtain medication
• Doctor shopping – visiting multiple doctors, complaining of the same symptoms to procure multiple opioid prescriptions.

Addressing Patients with Potential Opioid Abuse Disorder

Whenever a dental patient exhibits signs of an opioid use disorder, dental professionals should not be afraid nor hesitate to engage in an open discussion with the patient about their abuse habits. The conversation should be handled nonjudgmentally and gently, and involve three steps – feedback, advice, and goal-setting.

• Provide feedback to express your concern about the patient’s opioid abuse habit.
• Advise how he or she can handle their pain in other ways or cut down their opioid usage.
• Set goals after seeing the patient’s positive reaction to your recommendations. Ask them for their thoughts and how they plan to change their habits (if they are ready for it).

SMART recovery program includes a 5-step interviewing process as a way to motivate and encourage a change in behavior.

Referral to Addiction Specialists

Feeding an underlying addiction versus managing a patient’s acute pain can be confusing, and dental professionals have to build a referral base of addiction specialists, pain management doctors, and psychiatrists. The most important reasons to refer these patients to addiction specialists are:

• Mental health symptoms
• Unwillingness to try other medication options or pain treatments
• Abusive medication use
• Opioid use disorder being treated with buprenorphine/naloxone or methadone
• Experiencing impairing and persistent pain
• Excessive alcohol use

Getting completely rid of opioids is impossible because certain patients are not able to use NSAIDs for a range of other medical reasons. In those situations, dentists must rely on guidelines for prescribing options. As for opioid abuse, everyone is aware of the impact addictions have on our society. This problem should force us to rethink the use of opioids as the first-line treatment for acute dental pain.

Dental Specialties Institute Inc. is one of the best providers of education for Dental Assistants that teaches future dental professionals on the importance of turning to non-steroidal anti-inflammatory drugs for treating acute pain.