Opioid Painkillers After Oral Surgery May Put Teens at Risk for Later Opioid Abuse

Most parents worry about their teens getting access to drugs at school or in social settings – not at the dentist. However, the American Dental Association and private insurers have expressed concerns about the widespread practice of prescribing opioid painkillers to teens after oral surgeries. The patients who filled those opioid prescriptions were nearly three times as likely to use opioids in the year after the prescription.

Teens Are at Risk for Substance Abuse

During the past decade, opioid addiction rates exploded across the country and created an ongoing public health crisis. Centers for Disease Control (CDC) statistics show the rate of drug overdose was four times higher in 2018 compared to 1999. In 2018, almost 70% of drug overdose deaths involved an opioid.

Public health professionals have become concerned about the intersection between legitimate opioid prescriptions for teens and later opioid use and addiction. The American Academy of Pediatrics Journal addressed the issue of teen opioid use in 2015:

“Legitimate opioid use before high school graduation is independently associated with a 33% increase in the risk of future opioid misuse after high school. This association is concentrated among individuals who have little to no history of drug use and, as well, strong disapproval of illegal drug use at baseline.”

During adolescence, teen brains are still developing. That makes them particularly susceptible to a drug’s effect on the reward pathways in the brain. Parents and prescribers need to be alert to common risk factors for teen substance abuse.

Wisdom Teeth Extraction Can Lead to Opioid Misuse

Insurers and dental professionals are looking closely at “best practice” pain management strategies for children and teens. A2015 study of private insurance patients age 16-25 found 13% of participants had received at least one opioid prescription, and dentists wrote 30% of them. Within the next year, 5.8% of those patients were diagnosed with opioid abuse.

In 2019, Delta Dental reported:

Compared to their peers around the world, teens in the United States are much more likely to be prescribed opioids after wisdom tooth extraction. Many American teens leave their dentist’s office with a prescription for hydrocodone, also known as Vicodin or Norco. Almost all of this drug’s supply worldwide — 99% — is prescribed and used in the U.S.

United Healthcare (UHC) launched an initiative to “limit teens’ exposure and inform dentists, patients, and parents about opioid medications.” The company’s public education efforts include radio and TV public service announcements and a public toolkit. The toolkit includes a downloadable dental opioid flyer and checklist and other educational materials.

UHC implemented a new in-network pharmacy policy that “limits all first-time opioid prescriptions for people age 19 and under to no more than three days and fewer than 50 morphine milligram equivalents per day, as recommended by the Centers for Disease Control and Prevention (CDC).” The company also created an outreach program to dentists who have a pattern of “prescribing opioids outside of CDC guidelines.”

Questions to Ask the Dentist about Pain Relief

The National Institute on Drug Abuse for Teens has a list of suggested questions to discuss with your dentist before filling a prescription for opioids:

• Ask if there’s an option other than prescription opioids to treat your pain. Some non-opioid medicines might offer the best balance between benefits and risks.
• Tell the dentist about any substance use disorders or addiction in your family. This will help the dentist decide if opioids are safe for you.
• Talk about your medical history and any medications you’re taking. It might not be safe to take opioids with some other medicines.

The vast majority of medical professionals are happy to discuss options with patients. They realize that patient education about opioids helps prevent misuse and encourages safe disposal of unused/unwanted opioid prescriptions.

Always Safely Store and Dispose of Opioids

Two=thirds of teens who report misusing prescription pain medications got them from friends, acquaintances, or family members. Many people have extra: a 2017 meta-analysis found up to 92% of people don’t finish their prescription painkillers, and fewer than 10% safely dispose of the leftovers. Three-quarters of patients fail to keep opioids in a locked cabinet.

Safe disposal of unused/unwanted medication is just as important as safe storage. Consider the community and environmental effects before flushing medication or throwing it away with household trash. This infographic highlights the dangers of improper disposal of medication and pharmaceutical wastes.

Households and professionals alike share a responsibility to protect America’s teens from indiscriminate access to opioid painkillers. Ensuring residual medications are properly disposed means those same medications no longer pose a threat to our vulnerable youth.

As part of their patient education efforts, we encourage dentists to discuss safe disposal options for unused/unwanted opioid medications. For example:

• Provide information about nearby MedSafe medication collection receptacles in nearby pharmacies or other public locations.
• Offer the patient a TakeAway Medication Recovery System envelope along with the prescription.
• Provide the dates of semi-annual Prescription Drug Takeback Day events – if the local community participates.

In addition to offering safe, convenient pharmaceutical disposal solutions to generators and ultimate users, Sharps Compliance also helps dental offices comply with other waste disposal regulations regarding dental carpules, amalgam recycling, and more.