Stop letting the Dentist shove opiates down your throat.
I was standing in my office in downtown St. Louis when my phone buzzed to let alert me that I had received a new text message. My best friend, Brandon Reid, had just had seen the Dentist and was leaving the appointment. He stopped to message me from his car. Brandon is a well-known leader within the social services arena and within the LGBT and recovery communities. His text caught me off-guard as I glanced at my phone.
OMG I’m at the dentist, They just prescribed me an opiate. I don’t know what to do.
Take Ibuprofen. Give the prescription back.
I know that…
Then why did you ask what you should do lol
Well I have a very serious infection in my tooth. They are concerned the pain is going to be intense. I am on antibiotics.
Is the pain bad? Worse than when you were dope sick in a St. Charles County jail cell?
No, lol. They said ONLY if I need it.
Don’t even fuck with that. Take Tylenol and Motrin.
I know. I’ve just never had anybody prescribe me an opiate since I got sober.
Any they shouldn’t have. Did you tell them that you are in recovery?
In the moments after I read the message, my mind recounted the numerous, and by now familiar, cases that started similarly. I have seen it countless times, the path of dependence and subsequent addiction begins with a legal prescription for powerful opiates. More than 40 percent of all U.S. opioid overdose deaths in 2016 involved a prescription opioid. This situation is especially frustrating since other medications work to relieve pain and discomfort. Our society believes that the only tool to address pain is opiates. As a result, the pharmaceutical industry has thrived.
As I responded to Brandon, initially, I was concerned, but the concern soon changed to anger. I was not angry at Brandon, but at a system that was setting him up for failure. Two scenarios happen commonly around the United States daily. First, a person who has never taken opiates is given a prescription for Lortab, Norco, or Vicodin to manage their pain. A second scenario is a person prescribed opiates to manage pain that does not yet exist. Both are recipes for disaster.
Brandon said that he felt conflicted. Like the minute the Dentist offered him opioids, he reverted to the “dope fiend” mind. As a result, he began to panic. He said, “The fact that opiates are available, it is in the back of my mind, I know that it is there. That is how I know that I am an addict for life.”
Who prescribes the most
Dentists are among the most frequent prescribers of opioids in the United States, second after family physicians. While per capita prescribing of opioids is decreasing nationally, dental prescribing rates are increasing. Studies in the United States have shown that dentists recommend and prescribe opioids over non-steroidal anti-inflammatory drugs, in higher quantities, and for longer than necessary to control dental pain. Annually, an estimated 1 million opioid pills prescribed following tooth extractions remain unused in the United States. Furthermore, dentists are responsible for one-third of opioid prescriptions to adolescents, a vulnerable population for opioid misuse. Dentists are one of the most frequent US prescribers of opioids despite data suggesting that non-opioid analgesics are similarly effective for oral pain.
A Dentist may be the first to prescribe an opioid to an adolescent after molar extraction, which is often elective. It is essential to know that the research has shown that medical use of prescription opioids is highly correlated with the non-medical use of prescription opioids among high school seniors. So in this regard, our children’s first dope dealer is not some insidious criminal figure but rather a trusted clinician seeking to give them a Hollywood smile. Among adolescents who reported both types of use, medical use generally came first. Increasingly, Dentists are being encouraged to prescribe non-opioid analgesics for this population instead.
Dentists have also been provided with recommendations for how to counsel patients if prescribing an opioid pain medication:
- They should ask about any other medications that are currently being taken, and whether there have been issues substance abuse, such as with alcohol, prescription medications, or illicit drugs.
- The Dentist should explain the risks of taking the medication.
- The Dentist should describe how to take medicine and how long to take it.
- It should be explained that alcohol should never be used when taking opioid medication.
This imperative means that families need to ask questions about the medications that are being prescribed to their loved ones.
The scarlet letter
Brandon could have been forthcoming with the Dentist about his substance use history and avoided the situation, but I understood Brandon’s trepidation. As I talked with Brandon, he reminded me what countless others had told me before. No one wants to be labeled as an “addict.” Once that is on your file, it is a label that carried forever. It is the scarlet letter that you are labeled with, a “drug-seeker” at the mere mention pain or discomfort. Although addiction is a mental health condition, the stigma carries into every aspect of health care.
My history of substance use is not something that needs to be continually be brought up. “Hi, my name is Aaron, and I use to have an issue with substance use. Nice to meet you for the first time”, said no one ever. In a perfect world, we would all be lucky enough to have a great relationship with our healthcare provider, which is supporting, nonjudgmental, and allows for honesty, but that is not the case for everyone. Furthermore, I do not want to relive my substance use history every time I meet with a provider, especially when I do not feel well.
A common pattern
As a psychotherapist focusing on addiction, I encounter individuals daily who recall how their lives have spiraled off track due to the addiction to legally prescribed opiates. The prescribed opiate is even more dangerous since that legal prescription gives a sense of legitimacy, the idea that a person must need it; otherwise, it would not have been prescribed.
In some cases, the injuries or illnesses were significant, and in other cases, the pain could have been controlled through over techniques. As a new father, there is no way that I would allow a dentist to prescribe my child powerful opiates. While I certainly do not want him to be in pain, I also do not want to risk a situation where he will become dependent on them.
Had this not been Brandon Reid, with more than six years sober and solid recovery plan, this could have easily lead to relapse for a person. This scenario might have been the introduction to a person never been exposed to opiates before. Opiates, whether from the street dealer or the pharmacist give the same high, and the same death. Brandon did not get that prescription filled, but what about the next person?
Severino, A. L., Shadfar, A., Hakimian, J. K., Crane, O., Singh, G., Heinzerling, K., & Walwyn, W. M. (2018). Pain Therapy Guided by Purpose and Perspective in Light of the Opioid Epidemic. Frontiers in psychiatry, 9, 119. doi:10.3389/fpsyt.2018.00119