Drug addiction. It can start off small and it can either be broken quickly or, like in many cases of drug addiction, it can grow legs and become a beast that is hard to kill and even harder to get the user to want to kill.
The Reality of Abuse and Addiction
It is common knowledge in our day and age that opioid abuse is a reality, in fact, some health care providers get their patients to sign a consent form before prescribing them. This addiction is taking grip and destroying lives of not just the individuals, but also all those that love them. Over 2 million Americans abuse prescription drugs according to a nation-wide held survey. In the last 15 years alone, 165,000 deaths involved the use of heroin or opioids, and many more people are struggling with an on-going battle with addition.
The question is not – who to blame but rather what can be done now to curb the opioid abuse that is so prevalent in America. Therefore the responsibility must begin with those that have the authority to prescribe these drugs in the first place.
The dental community provides more opioids to teens than any other healthcare provider.
Why? Along with common-place tooth extractions – 3.5million people have their wisdom teeth removed each year (largely of adolescent age) – patients are also prescribed a bottle of opioids such as Vicodin and Percocet for post-op pain relief. Yet the amount they are given versus the amount a patient actually needs is alarmingly high. Excess opioids that are not used are often left in a medicine cabinet or worse illegally re-sold.
With stats being brought to the fore such as one study finding that adolescents exposed to opioids, even with a prescription, have a 33% higher risk of abusing pain-killers later in life. The spotlight is now appropriately being placed on the dental community and many are rising to the challenge to change their habits and thinking in regard to how and when they prescribe opioid drugs to patients.
No one is saying that health care providers are the ones to blame. But they do wield the power to curb this epidemic. Yes, addiction is much more complicated than giving a person a bottle of Vicodin. So how does addiction start? And why do some get addicted?
The Face of Addiction
Opioid addiction often begins by accident. A patient is given a prescription of painkillers to aid in coping with pain. Since no one likes physical pain, the relief the opioids give to pain suffers becomes addictive – opioids target a specific part of the brain that deals with reward and reinforcement behaviors. The body adapts to the drugs and develops a tolerance and demands a higher dosage to ease the pain. Even the most careful user can become dependent and as the withdrawal symptoms of coming off painkillers can be quite severe – vomiting, anxiety, muscle pain, severe fatigue – it becomes easier to slip back into opioid dependence. And this is how opioid use becomes a slippery slope into opioid abuse.
Addiction, especially among teens, can start off quite innocently. Take for example James Hatzell, from Collingwood, NJ, who is now a technology officer for a college addiction treatment program.
Hatzell recalls his first time receiving a bottle of prescribed painkillers. Little did he know this would begin a long-drawn-out relationship with a life destroying drug.
“We’re in our 2001 Honda Odyssey minivan, driving to the dentist,” Hatzell recalls. “And we get there, and I’m just pumped. I was very excited to get my wisdom teeth out.”
His excitement, of course, had nothing to do with getting his teeth extracted. Hatzell had heard from friends that following the procedure, you get your very own bottle of prescribed opioids. Previous to this, Hatzel had tried Vicodin with caution. A friend would find an extra pill in the medicine cabinet at home; they’d crush it, mix it with pot, and share it.
But now Hatzell had his own legitimate bottle of pain-killers and since it was given by a health care professional maybe it wasn’t as dangerous as he had once thought. He soon started abusing the drugs and became addicted, he says.
After much derailing of his life and his family’s, James Hatzell did get his life back together, he fought the addiction and killed the beast – so to speak. Yet he says he still fears the day that he may need surgery and again need pain medication.
This is one story out of thousands that can be told in America alone. Some won the fight, others are still battling, and sadly some have been defeated completely.
The Future of Opioid Prescription
In 2014 Dr. Joel Funari, a dentist who specializes in oral and maxillofacial surgery in Devon, Penn., joined a group tasked by the Pennsylvania Department of health to develop prescribing guidelines for dentists. Looking intently into the science of dental pain and treatment, he and his colleagues realized there is a better and safer way to treat general dental pain.
“Non-steroidal anti-inflammatory drugs — the Motrins, the Advils, the Aleves — when used in a certain way, are very effective,” Funari says. “More effective than the narcotics.”
The 2014 guidelines that Funari and his colleagues came up with are the state’s first to tackle how to best use a combination of opioids and other drugs to manage pain in dental patients. National discussions have been expanding as well.
It is the effort of these forerunners combined with awareness through the dental community and dental students to be wiser prescribers of these powerful drugs. This effort can evoke change in the mentality of prescribing appropriate medication and amount of said medication to patients, with the intent to curb opioid abuse. The responsibility is on each practitioner, dental professional, and dental student. The power is in their hands but it begins with acknowledging and respecting the strong hold these drugs can have on their users.