Prescription Drug Abuse and Dentistry Pain Management

For a dentist to attain credentialing for license renewal in the State of Wisconsin, they are required to complete 30 hours of continuing education. In 2023, the Drug Enforcement Agency required prescribers of controlled substances take an additional 8 hours to identify, treat and manage patients with opioid or other substance abuse disorders in an attempt to reduce abuse. Last week I completed one of these courses at the Marquette University Dental School, and had a realization that this is an essential topic to discuss.

To truly understand why prescription drug abuse has achieved the definition of a “crisis,” one must first understand the history and classification of drug. An opioid is a “classification of drug derived from, or mimics, natural substances found in the opium poppy plant.” Historians have recorded opium being utilized by Arabic physicians as early as 1000 A.D. to treat diarrhea and diseases of the eye. It would not be until the 1800’s that morphine would be derived and developed from opium. Addiction to both opium and morphine became rampant throughout the Civil War, misnaming the addiction as “the soldier’s disease”. At this time, physicians would prescribe these drugs for pain, tuberculosis and other respiratory diseases. In 1898, the Bayer Company started producing the “wonder drug” heroin, discovered by acetylation of morphine, and proving to be more effective than morphine; as well as help to treat addiction to these drugs. However, similar to its predecessors, patients would eventually develop an intolerance, and heroin abuse spread rapidly. Needing a solution to the crisis, “The Geneva Convention of 1925” was formed, creating international laws that sanctioned the manufacturing, sale, and use of these drugs exclusively for medical and legitimate purposes.

With the advent of newly formulated prescription opioids like Oxycontin and Percocet, the United States has now reached an even worse drug epidemic. Since 1980, there has been over 1,000% increase in prescription drug overdose related deaths. From 2000-2010, the clinical use of prescription opioids has quadrupled resulting in a 300% increase in drug-related deaths, and illicit abuse of heroin and fentanyl have sky rocketed. History once again repeats–a tolerance of legal drugs by addicts now resorting to illegal drug use.

In 2018, Stanford published a report finding a link between teenagers and young adults receiving opioids from dental providers and an increased risk for continued opioid abuse. This correlation has led to development of new protocols for pain management, advised reduction in quantity of prescribed opioids and online prescription drug monitoring programs. There is no question that extensive dental surgery can cause pain, but this report makes it mandatory for your dental provider to manage pain with the knowledge that their patient could become addicted. Studies now support that pain control for extensive dental care can be managed with limited to no prescription narcotics, recommending simply alternating Tylenol with Ibuprofen that shows the same or better pain management than narcotics.