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Dentistry and Prescription Drug Abuse

The United States' biggest illegal drug problem is marijuana. Can you guess what the second biggest illegal drug problem in the United States is? Prescription painkillers.

Did you know that dentists are second only to general practitioners in terms of the volume of pain medications they prescribe?

A Story of Dental Drug Seeking

Drug Addicts Try to Get Painkillers from DentistsLast week I was volunteering at a community dental clinic in a rural area. We had a few cancellations that day and we agreed to see an emergency patient who stated that her tooth was hurting her.

I brought her back and had her sit down in the dental chair. After performing an exam and taking an x-ray, the tooth seemed in great condition.

I started to get suspicious when she asked me if we gave out pain medication following an extraction. When I told her that we did, she said, "Great - I already know which ones I want!"

Drug Seekers and Dentistry

This article from TIME Magazine's website talks a little bit more about the problem of prescription drug abuse.  It says that more than 2/3 of people who abuse pain medication get it from a friend or relative's medicine cabinet.  So many people save leftover pain medication just in case they get severe pain in the future and end up needing something stronger than the typical over-the-counter pain medications.

The article talks about a dentist named Dennis Bohlin who wanted to call in a prescription for one of his patients.  It says:

Bohlin, himself a long-term recovering addict and an expert on addiction in dentists, recently got fooled by a patient requesting an opioid prescription. "I called the pharmacy and they said, 'We won't fill that,'" because apparently she was known to them as an active addict, he says.

"We have to respect people's pain," says Bohlin, who will treat recovering addicts with opioids if necessary, but will often have a significant other or recovery sponsor take charge of the drugs. "That's why this is such a complex problem."

I agree with Bohlin that we need to respect people's pain.  It is wrong to conclude that someone is not experiencing pain just because they have a history of abuse.  That being said, it's difficult to remain objective and not be judgmental when you are treating a patient with a known history of narcotic abuse.

Although in the minority, I have had patients tell me that they are recovering addicts and that I shouldn't give them any prescription painkillers.  Sometimes they will simply ask us to prescribe a stronger version of over-the-counter Motrin [ibuprofen].

Motrin (ibuprofen) is actually very effective in treating dental pain.  I recently read a study for one of my anesthesia courses that discussed the effectiveness of ibuprofen in dental pain relief.  It surveyed patients and found that a few hours after extractions, ibuprofen was stronger than drug mixtures of asprin and codeine.

It said, "Postoperative dental pain typically is caused by tissue injury and inflammation and usually has a short duration; as a result, NSAIDs in combination with acetaminophen should be considered the first-line analgesic regimen for most patients."

Addicted to Painkillers?  How to Get Help

If you or someone you know has a problem with an addiction to painkillers, you are not alone.  There are treatment programs available that can help you overcome this problem.  This page from the United States Office of National Drug Control Policy gives some helpful pointers on how to report illegal prescription drug abuse and how to help your loved ones that may have succumbed to this sort of drug abuse.

Do you have any questions, comments, or concerns about prescription painkillers and dentistry?  I'd love to hear what you have to say in the comments section below.  Thanks for reading!


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3 Comments |  Leave A Comment

  1. Tramadol (Ultram) might be a medication to consider; it is commensurate to about 60mg
    of Codeine, but markedly weaker than hydrocodone (or anything higher).

    Even still, however, in my opinion, it is an addictive drug, and although not controlled, it should be.

    • Thanks RJ - The dentist in our emergency dept. suggested that Tramadol is a good option to give to patients who seem to be looking for drugs. He actually offered it to one patient and she refused saying that she wanted something stronger. She left the school pretty upset that we wouldn't give her anything stronger!

  2. I just had an incisor extracted, a molar extracted and five fillings and a deep cleaning. I'm in pain management with Chiari 1 Malformation and failed neck surgery(my rods in my head were removed and the rods from my skull to c4 were removed as well),

    Now, I have bad teeth and recovering now from a semi-truck accident where I was the first recipient of the 6 car pile-up. I am prescribed oxycodone for neck and upper back pain. I have never ever abused my pain medication. However, in Pain Management, the doctor or dentist treating your condition is responsible for helping with the acute pain - whatever it may be.

    On Wednesday I was in the dentist chair for six hours with the extractions, fillings and deep cleaning. I was prescribed ibuprofen and anti-biotic. The sutures are sticking out into my upper lip. I am applying ice to the swollen area under my right nostril. I'm in a lot of pain. I called my dentist who said because I was on oxycodone that I should take my ibuprofen and she apologized. I'm in constant pain the ibuprofen doesn't really help with the pain I'm experiencing.
    I really hope dentists start to realize that acute pain and chronic pain are two different things - I've been in tears cause a) I'm in pain from the extractions and b) I feel embarrassed that I'm being treated like a drug seeker - which I am not. I've been in Pain Management for 9 years and never failed a pill count, a UA, and now working on titrating my pain medication down.
    I'm in tooth pain and she doesn't get it. Why should I suffer with what she (the dentist) says is until Sunday???

    I welcome all comments - please don't give me a hard time on that I should be someone I'm not. I've been through the wringer and now I feel a stigmatized by this dentist.

    Would it be wrong to confront the dentist with a letter or in person when the sutures are removed a week from Monday? I would also like to fire her as well. I think a dentist should be more compassionate than what she has been with me.
    Best,
    Kat

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Tom, Creator of Oral AnswersHi, I'm Tom. I recently graduated from dental school and am now a dentist in Bridgewater, Virginia. I started this blog to help people take better care of their teeth. You can learn more about me or ask me a question.

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