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The opioid epidemic and how dentists can help

The COVID-19 pandemic has overshadowed a decades-old opioid epidemic that refuses to abate. Although less media coverage focuses on opioids, the deaths from overdose continue to accelerate. As serious as the coronavirus pandemic is, dental professionals cannot afford to lose sight of the devastation caused by prescription opioid pain medications.

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What is an opioid?

An opioid is a chemical made naturally from the poppy plant or synthetically in a laboratory. Morphine and codeine, two of the most well-known naturally occurring opioids, are also referred to as opiates. Synthetic medications include methadone, Demerol, Ultram, and Fentanyl. The third type of opioid, semi-synthetic, is a synthetic product made from naturally occurring drugs such as morphine and codeine. Semi-synthetic opioids include heroin, oxycodone (Percocet), and hydrocodone (Lortab).

 

Our brains and other body organs have specific receptors on their cells to help in functions such as digestion. When an opioid attaches to receptors in the brain, it has various effects, including:

  • Dulls perception of pain.
  • Slows breathing.
  • Constipation.
  • Drowsiness.
  • Nausea.
  • Confusion.
  • Euphoria.

An interesting side note to the opioid story is what the researchers who discovered the brain’s receptors found at the same time. Once the researchers at Johns Hopkins found the receptors, they questioned why they would be there. They soon realized that the brain had a natural chemical similar to morphine called endorphins. 

 

Endorphins have a similar feel-good and analgesic effect as opioids. They make you feel good when you exercise and help you cope with pain and stress.

What is the current state of the opioid crisis?

Dentistry takes place in a very sensitive area. There are more than one million nerve endings in the lips and many more in the palate, tongue, teeth, and gums. Dental procedures such as extractions, periodontal and oral surgery, implant placement, and root canal treatments can cause moderate to severe pain. To provide relief, dentists depend on prescription pain medications that include opioids.

When taken for a short period to relieve acute pain, opioids are safe for most people when properly prescribed. Problems develop when the dosage prescribed is too high or taken for a prolonged period. One of the problems with prescribing opioids is that patients develop tolerance which causes them to take higher and more frequent doses to achieve the same effect.

 

Initially, physicians prescribed opioids for the relief of pain associated with cancer. With the pharmaceutical companies’ assurance that patients would not become addicted to the medications, healthcare providers started prescribing opioids for less severe pain. It soon became clear that these drug manufacturers misled providers and that opioid medications were highly addictive. 

 

Almost 400,000 people died from an opioid overdose from 1999 to 2017. In 2019, almost 50,000 people died from overdoses of prescription pain medications, heroin, and synthetic opioids such as fentanyl. The estimated cost of the opioid epidemic approaches $80 billion. One study suggests that the societal burden of the crisis in 2017 alone was $1 trillion.

The number of deaths and the financial and societal burden of the opioid epidemic brought forth much media attention and many lawsuits. However, there seems to have been little impact on healthcare providers' prescribing habits, including dentists in the United States. Americans consume four-fifths of the world's opioids while being only five percent of the world's population.

For years, dentists have known they are part of the opioid problem. A recent study from the University of Pittsburgh highlighted dentists’ role by concluding that up to half of the opioids prescribed by dentists are excessive and inconsistent with appropriate use. Those most affected by this practice are at higher risk of substance abuse and death from an opioid overdose are males and young adults. The authors of the study urge dentists to seek evidence-based protocols suitable to treat oral pain.

The COVID-19 pandemic has garnered healthcare providers' attention, including dentists and the American Dental Association.  It might be debatable whether we made any progress in the fight against opioid addiction before the pandemic. The Centers for Disease Control reported an increase in overdose deaths in the months before the coronavirus pandemic and an accelerated rate during this challenging time.

What are the signs and symptoms of opioid addiction?

Dentists, dental hygienists, and dental assistants usually get to know their patients very well. As dental professionals, we are well-positioned to notice changes in our patients. To prevent or help someone struggling with opioids, we need to know what to look for. Here are some signs and symptoms that someone may need help with opioid addiction.

  • Unexplained drowsiness
  • Weight loss
  • Lying about the presence of pain
  • Frequent flu-like symptoms
  • Problems with performance or absence from work
  • Isolation from other people
  • Stealing
  • Deterioration of personal hygiene
  • New difficulties with finances
  • Constricted pupils
  • Nausea and vomiting
  • Difficulty concentrating
  • Irritability
  • Depression
  • Paranoia
  • Red, itchy skin
  • Mood swings

Can opioid addiction be treated?

Some people become addicted to prescription opioids while trying to manage pain after a medical or dental procedure. Others’ addiction occurs while undergoing treatment for chronic pain such as TMJ dysfunction. No matter what the circumstances of the addiction, recovery is possible. The success of treating opioid addiction varies according to:

  • The severity of the addiction
  • Alcohol use
  • Presence of mental illness
  • Patient’s social environment
  • Family support

The greatest opportunity for successfully treating the addiction includes:

  • Medications to help alleviate withdrawal symptoms.
  • Stress management.
  • Counseling.
  • Support groups.
  • Rewards systems.
  • Motivational interviewing.

Dental professionals need to proactively reach out to help patients they suspect have an opioid addiction and direct them to professional help.

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The way forward for dental professionals

Dental professionals are typically compassionate individuals who seek to help relieve their patients’ pain. The ongoing opioid epidemic makes it essential to evaluate how to accomplish this without placing patients at risk for addictions to potent pain killers. As we look to navigate this complex problem during a complicated viral pandemic some, we may consider are:

  • Educating patients on the difference between acute and chronic pain
  • Recognizing that many young people receive their first narcotic at their dentist.
  • Using non-narcotic analgesics more often as the drugs of first choice.
  • Diligently screen patients for opioid abuse.
  • Compassionately aid people in getting the necessary treatment to recover from their addiction successfully.

There has never been a better time to enter dentistry, a profession committed to patients' oral and general health. Cloud Dentistry can help you enjoy a rewarding and fulfilling career as a dental professional.

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