Medical doctors, dentists and other licensed practitioners commonly use prescription opioid or narcotic medications to help elevate pain after surgical procedures. These medications are also used to treat chronic ailments or other conditions that cause people pain. Despite the importance of these drugs, they are sometimes overprescribed and have led to an alarming and growing epidemic of drug dependency, related criminal activity, overdose, and death. In 2010, a comprehensive study by the Centers for Disease Control and Prevention revealed that nearly 60 percent of the drug overdose deaths (22,134) involved pharmaceutical drugs and 75% of these deaths involved prescribed opioid painkillers. A 2013 study from Trust for America’s Health found that here in Pennsylvania, we have the 14th highest rate of drug overdose deaths and most of those deaths involved the use of prescription drugs. Prescription drug related deaths now outnumber those from heroin and cocaine combined.
Recently Fred Harran, a patient of mine, and the Director of Public Safety for the township of Bensalem invited me to a community meeting aimed at tackling this drug epidemic head on. Local medical doctors, dentists, physician’s assistants, pharmacists, emergency medical technicians and other concerned community leaders attended the meeting that was chaired by Harran. During the meeting, Harran described the scope of the problem both locally and nationally, and invited comments and written responses from those in attendance. The hope is that the contributions from area practitioners will both raise awareness of this issue and create new ideas to curb the potential for drug abuse and its devastating consequences. The innovative approach was conceived in a mandatory meeting of all Bensalem police employees and approved by both Harran and Bensalem Mayor Joseph DiGirolamo.
Those of us who have the great responsibility of dispensing opioid medications must use these drugs judiciously. When treating patients, we need to balance the legitimate need to help reduce a patient’s pain, while being careful stewards that do not create drug dependency. Over the years, the drug policy of my dental practice, The Dental Comfort Zone, has been designed to help achieve this balance. This is what we do:
- We encourage patients to take over-the-counter pain medication like Advil, Tylenol or Alleve if needed after minor dental procedures including routine dental surgery like uncomplicated extraction of teeth, gum procedures, and biopsies.
- When more advanced procedures are performed such as surgical dental extractions,root canal or gum surgery, we often recommend prescription strength Ibuprofen like Motrin 800mg for pain. It is much more effective than most people realize.
- We educate patients that treatment of their condition, such as a root canal orextraction, is the best way to eliminate dental pain, not medication. In some cases, we use a shot of long acting local anesthesia to reduce pain after a surgical procedure. It works betterthan medication and does not contribute to drug dependency or addiction.
- We rarely prescribe highly addictive drugs like oxycodone that is found in thedrug Percocet. When an opioid drug is needed, we prescribe less addicting medications like Tylenol with codeine or hydrocodone and limit the quantity to 8, 10, or 12 pills. No refills.
- We do not prescribe opioid pain medication to anyone who is not a patient or to any patient who calls the office and has not been seen in more than a year. These patients are told to come to the office for diagnosis and treatment.
- We do not prescribe opioid medication to anyone under 21.
- People who are addicted to opioid medications often “doctor shop” to stockpile medications. When we suspect this is the case, we ask the pharmacist for a drug profile or list of medications for the patient. We will not prescribe to anyone who has had opioid medications prescribed recently from other practitioners.
- We encourage patients to throw away any prescribed opioid medications when they are out of pain. Pain medications left in the drug cabinet invites the potential of misuse by those who it was given to and for family members.
- We never prescribe opioid medications to anyone that has a history of drug addiction. This is a question we ask on our health questionnaire, and also talk to the patient or a family member if addiction is suspected. This is a sensitive issue and HIPAA privacy laws apply, but the importance of this safeguard is worth the effort.
- When drug addiction and doctor shopping is suspected, we communicate this concern with any other practitioner that we refer the patient to as long as it is not in violation with HIPAA laws.
The war on drugs might be over, but in a sense, a new war has taken its place. We as doctors and other health practitioners can be part of the problem or the solution. Community leaders and legislators need our help, so reach out to them with what is working for you and your patients. When you do, powerful forces will come to your aid, like our Director of Public Safety Harran. When I asked him why he set up the meeting he told me “I’ll try anything within my Legal, Ethical and Moral means to combat this epidemic that is KILLING our country.”
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). To learn more: https://dentalcomfortzone.com/staging