When Dentists Should Prescribe Opioids—and When They Shouldn’t
Every day, 90 people die in the United States from an overdose that involves an opioid. At least 2 million people suffer from opioid use disorder (OUD). The National Institute on Drug Abuse reports that nearly half of the young people who now inject heroin used prescription opioids first. 1 As the opioid epidemic worsens, it’s vital that our profession takes a close, hard look at our role in addressing and preventing opioid abuse.
In 2012, healthcare providers in the United States wrote 259 million opioid prescriptions. Dentistry’s contribution to this enormous number is significant, as 12% of all immediate-release opioids such as oxycodone and hydrocodone are prescribed by dentists, with some reduction in recent years.2, 3 Third molar extractions, the most common surgical procedure, often are followed by an opioid prescription to control the postoperative pain.
It is important to note that dentists prescribe opioids for these extractions and other procedures for a relatively short period of time. But in the case of third molars, that equals 3.5 million young people with an average age of 20 years who are exposed to opioids each year.2 The question is if these prescriptions can and should be avoided.
Studying the Issue
I had the privilege of recently serving alongside many experts on a committee of the National Academies of Sciences, Engineering and Medicine that was charged with studying pain management and opioid misuse. As the only dentist on the committee, I was able to share with the other healthcare professionals how opioids are used in dentistry, and I was enlightened about their use in other healthcare disciplines as well.
For a year, we studied the complicated issue and produced a report with key findings and recommendations to better address this major public health problem. Generally, trends indicate that premature deaths associated with the use of opioids are likely to climb and that opioid overdose and other opioid-related harms will dramatically reduce quality of life for many people for years to come.