New Study: Are Dentists Contributing to Pain Killer Abuse?

Thursday, July 14, 2011

Maggie Lange, GoLocalProv Contributor

There is a reason that people compare something terrible to having a toothache. There is a reason that people compare trying to get a reluctant person to do something to pulling teeth. In Notes from the Underground, Dostoevsky writes about the pain of human suffering in terms of a toothache. Dental pain is universally considered to be the absolute worst.

So it makes sense that there should be strong substances used to relieve this pain. However, the painkillers used to alleviate dental pain are often abused and misused by patients or their family-members, including adolescents, as demonstrated by a report released this month.

In April, the Obama Administration brought prescription painkiller abuse to the forefront. The Office of National Drug Control carved out an action plan to combat the misuse of prescribed drugs.

Specific focus on dentists

This month, dentists have turned a spotlight on their own profession, with a cover article in the Journal of American Dental Association (JADA). Because dentists are the third largest group (after emergency doctors and family practitioners) to prescribe painkillers, their voice is crucial to the conversation.

The article involved the input of nine dentists, pharmacists, and addiction experts including Brown University’s George Kenna, an assistant professor of psychiatry and human behavior at the Warren Alpert Medical School of Brown University and an addiction psychologist at Brown’s Center for Alcohol and Addiction Studies.

What prompted this, says Kenna, was “the incidence that dentists had in drug-use initiation in adolescence. Most people had never thought of this, [but] the biggest way that children and adolescents get a hold of prescription drugs is at home in the medicine cabinet.”

The problem of leftovers

The JADA study notes that 41% of dentists surveyed acknowledged that there would be leftover pills in their prescriptions. Leftover pills account for the 70% of people who (illegally) acquired painkillers from a family member who had a prescription, according to the National Survey on Drug Use and Health.

“Also, a lot of this is their [dentists’] own fault. They don’t want to get paged and called in for pain,” says Kenna. “They have been trained in pain management, but not necessarily with substance abuse. They don’t know how to handle it, so the easiest thing to do would be to ignore the situation.”

Diligence to correct use

Dr. Steven Brown, an oral and maxillofacial surgeon, in Rhode Island, disagrees. “Every weekend when I'm on call I can count on getting a call from someone trying to obtain opioid pain medication,” he says.

He knows how to spot the fakers. He said that he has kicked people out of his office after refusing to give them pain medication and called the police “many times on folks that I know are imposters.”

Dr. Brown says every dentist he knows has experienced this. “Experience and professional judgment sort out the abusers,” he says, “It is absurd to think that dentists don't understand these problems.” The JADA article noted that 87% of physicians acknowledged that most recreational users of opioids obtained these drugs from a legal prescription.

Dr. Brown is part of this 87%, but he says that this is a necessary part of alleviating pain. “Unfortunately every patient is different. No one can ever accurately predict the exact number of pills the patient will require to control their pain. Limiting the quantity is an imperfect but necessary remedy.”

Dr. Barbara Cavicchio, the President of Rhode Island Dental Association, also agrees that the average dentist is not over-prescribing. “Usually the dentists are prescribing what they think a patient needs to get over an acute pain,” which is often only a four or five-day situation.

She says that dentists have an obligation to limit potential abuse. “I think that we do assume people do the right thing,” she says, “I’m into personal responsibility.”