With five million procedures each year, wisdom teeth removal is one of the most common out-patient procedures for young adults and often is one of the first times a person may have been prescribed an opioid.
For the past seven years, the Virginia Dental Association has been focused on training and educational opportunities for dentists to reduce opioid prescriptions. I have been an advocate for the change.
Eight years ago, my youngest son Adam died of an overdose of heroin laced with benzodiazepine after a brief addiction to heroin, preceded by addiction to opioid prescription medications. After being in recovery for approximately seven months, he rejoined the community with a full-time job and started night school at a community college to become an emergency medical technician. In September 2014, Adam was nine months into recovery when he suddenly relapsed and overdosed. Four days later, he died.
Adam was a generous person in his life and his death. As a teenager, he loved volunteering for community activities, including supporting a popular event in Henrico, Field Day of the Past, and serving as a volunteer firefighter in Goochland County in high school. He was generous in his death by choosing to be an organ donor. Four of his organs were used to save four lives.
His death has been a life-altering event for me and for my family. I was deeply impacted by the unbearable grief of losing my youngest child. Professionally, the experience brought home to me my past interactions with patients, my previous prescribing of opioids, and my teaching of pain management as an academic surgeon. To have a better understanding of it all, I enrolled in a graduate program in the field of addiction at VCU in collaboration with two other top international universities.
Since then, I have spoken, educated, and advocated on the opioid epidemic and addiction. Today, dentists across the country are much less likely to prescribe opioids. When a dental patient is given a prescription, he or she is given a lower dosage and fewer tablets.
Parents can serve as their own advocate or as their child’s advocate before and after an oral surgery. Here are some questions for parents to go over with their family’s provider.
When may my child need to take an opioid for pain?
The most important indication your child may need opioid medications for pain is when non-opioid single and combination medications are not effective in reducing the pain to a tolerable level for the patient. The rule of thumb is the first line of attempting to treat the pain is non-opioids, and when opioids are to be prescribed, it has to be of the lowest dose and for the shortest duration possible.
What are the risks associated with opioid use for pain related to the procedure?
These risks include temporary side effects such as nausea, vomiting, and constipation. Extended use (even more than 3 to 7 days) may lead to misuse and addiction.
Is there an alternative to opioids to manage postoperative dental pain?
A discussion should take a place regarding the possibility of using non-opioid analgesics for management of pain after a dental or medical procedure, their effectiveness, and advantages and disadvantages. This is very likely to depend on the expected severity of pain, which in turn can be influenced by the length of the procedure, the difficulty, and the time it took to complete the procedure and whether the tooth was infected or not before its extraction.
If an opioid is necessary, what should we do with any leftover tablets?
Most localities host events throughout the year when parents can take the leftovers to designated pharmacies and other locations. If you cannot find a drug take-back program near you, you can mix the medications with cat litter and dispose of them in the trash. It is generally discouraged to discard leftover medications into the drainage system.
Do you recommend any measures to prevent abuse?
The most significant predictor of long-term use after exposure to opioids is the initial duration of exposure to the drug. Parents should make every attempt to have the child use opioids for pain relief for the shortest period of time and only if it is absolutely necessary.
Only fill the prescription for the non-opioid and use it for initial pain management. Plan to use the opioid prescription as a backup only. If, after two to three days, the opioid is not needed, you can tear up the prescription.
Ask your dentist to give you non-opioid analgesics as a first line of managing the postoperative dental pain. If you were advised to use over-the-counter non-opioid analgesics different from what you may already have at home, make sure you ask your dentist to guide you on the adequate dose and the proper scheduling and appropriate duration.
If you or someone you know is struggling with opioid addiction, please visit curbthecrisis.com.