Recent federal and state laws aimed at reducing the devastating effects of drug dependency and addictions are a step in the right direction. The scope of the problem is daunting, with an estimated 2.1 million people in the United States suffering from substance use disorders related to prescription opioid pain relievers (OxyContin, Percocet, Vicodin, etc.) and an estimated 467,000 addicted to heroin, according to a 2013 study by the department of health and human services.
This summer, new bipartisan federal legislation was passed to provide more funding designed to improve prevention and education, have naloxone (Narcan), a drug used to reverse opioid overdoses, available for first responders, have the alternative of treatment programs in place of incarceration in certain instances, and other measures . In November of this year, a bill passed in Pennsylvania that limits the circumstances when doctors and other prescribers can dispense opioid medication to minors, reduces the quantity and restricts refills for patients seen in the emergency room, improves guidelines for training of doctors and other medical personnel, mandates related continuing education for all prescribers of opioid medications, and requires the reporting of all opioid drugs prescribed .
As valuable as these new laws are, they do not and cannot address how a doctor makes a decision on whether or not to prescribe opioid medications. Prescribing habits for many doctors begin during professional school in clinical rotations. Young student doctors and residents are influenced by attending doctors that they respect, because they lack the experience to know which drug to use in each scenario, and how much to prescribe. Presumably, the more experienced a doctor becomes, the more likely he or she will be able to use this improved perspective to make better decisions regarding treatment, including the management of medications required.
As a dentist, almost all of the treatment I provide would be considered minor surgical procedures. Most procedures performed by dentists or dental hygienists do not require any pain medication in the vast majority of cases. Of the remaining procedures, root canal treatment, and oral surgery, especially the removal of teeth, will often have a varying degree of pain for up to several days after treatment. In many of these cases, over-the-counter pain medication like Ibuprofen (Motrin) is sufficient. Still, the decision to prescribe opioid medication is ultimately up to the doctor. That judgment call is based on several factors, including the amount of trauma caused by the procedure, the patient’s tolerance to pain, the medical and social history of the patient (including possible past or present substance abuse), past experiences the doctor has had with the patient, and the doctor’s intuition about what is best for the patient.
The abuse of opioid pain medication is a serious problem. I first started writing about this issue back in 2002, and have long been an advocate of the need for restraint when prescribing these potentially addictive medications   . Although new laws can be helpful in combating this epidemic, ultimately it will be up to doctors to be the gatekeepers in both managing patient’s pain and reducing the potential for addiction.
Dr. Jerry Gordon can be reached at (215) 639-0571. Comments, questions, and second opinions are available at The Dental Comfort Zone, 2734 Street Rd. Bensalem, PA 19020 (across from the Giant supermarket).