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It’s no secret that dental professionals have had a (unintentional) hand in the opioid epidemic. This dentist wants the profession to be part of the solution, and here are his ideas.
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My parents grew up during the Depression and World War II. During that 15-plus-year time period, resources in this country were precious and nothing was wasted, especially food. As a child, my parents considered me a picky eater, and not finishing everything on my plate was considered bad behavior. My mother’s favorite phrase at our dinner table was, “No leftovers.”
Looking back, I understand that they were trying to teach me not to be wasteful or take more than I needed. This is a philosophy that holds true for many things. One place where it does not hold true, however, is for prescription medications.
In the case of antibiotics, if we don’t use them all and there are some leftovers, it’s not ideal, but at least these medications cannot be abused. But as we know, other medications, such as opioid pain medications, are frequently misused and abused. These are the medications where dental professionals must be diligent and not save any leftovers. There are two simple steps we can take to help prevent any leftover pain medications we prescribe from falling into the wrong hands.
Understanding the problem
Most of us have had leftover pain meds in our home medicine cabinets at one time or another. Medication can be expensive, and many of us feel that throwing away leftover pills is a waste of the money that we spent. What if the pain comes back and we need them again? If we save them, we’ll have some pills available if something happens again. Sounds reasonable, right?
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I think I'm done prescribing opioids
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Unfortunately, a high percentage of these leftover pills do not wind up being saved for a rainy day. The fact is that 40% of opioid prescription medications abused on the street are not purchased from a dealer or stolen from a pharmacy; they’re obtained for free from a friend or acquaintance.1
Many of us would never give prescription pain pills to someone, but what if a family member or visitor with a substance use disorder gets a hold of them? Do we know and trust all of our kid’s friends and everyone who comes into our home? They might explore our medicine cabinets, and without our knowledge those leftover pills could be gone.
What’s so insidious about these leftover pills is that most people consider prescription drugs to be safe since they’re prescribed by a doctor. This is true, but only for the person for whom the prescription was intended. But the perception of safety often remains until it’s too late. It takes as few as five days to become physically addicted to prescription opioid medications.2
Most people do not realize that it’s illegal to give a friend or family member prescription pain medication, even if it’s not for profit. It is also illegal to possess pain pills that were prescribed for someone else. Laws vary by state, but can carry steep penalties of fines or imprisonment if convicted.3
Although the number of overdose deaths caused by prescription opioids is declining,4 it is precisely these prescription drugs that lead to more dangerous street drugs when these pills become unavailable or the habit becomes too expensive to support.
Two simple steps for dentists
What’s the solution? As dentists, we must be extremely conservative when prescribing these medications to our patients. These steps that can help prevent the painkillers we prescribe from getting into the wrong hands.
Step 1: In general, we’re dealing with patients in acute pain. Regardless of the condition or the procedure, we can expect the acute phase of the patient’s pain to last two to three days maximum. We can help reduce the number of leftover pills by prescribing fewer pills for these patients.
Step 2: We must also be diligent in informing our patients about how to get rid of unused pills. The risks of saving them are just too great. There are numerous programs that take back unused pills, but these programs are available only at specific times and locations. People with full schedules may have a hard time using these services in a timely manner. Most pills can be disposed of by flushing them down the toilet, or by mixing them in used coffee grounds or soiled kitty litter to make them unattractive for consumption.
With very little effort, we as health-care professionals can be instrumental in reducing the number of prescription medications that find their way to the streets. By taking these two simple steps, we will be helping to reduce and hopefully end the opioid epidemic and crisis that’s plaguing our society.
William McGlashan, DDS, has been practicing dentistry since 1985 and is a graduate of University of Southern California Herman Ostrow School of Dentistry. He is currently an owner dentist supported by Pacific Dental Services in Renton, Washington.
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References
1. Han B, Compton WM, Blanco C, Crane E, Lee J, Jones CM. Prescription Opioid Use, Misuse, and Use Disorders in U.S. Adults: 2015 National Survey on Drug Use and Health. Ann Intern Med. 2017;167(5):293-301.
2. Shah A, Hayes CJ, Martin BC. Characteristics of Initial Prescription Episodes and Likelihood of Long-Term Opioid Use — United States, 2006–2015. MMWR Morb Mortal Wkly Rep. 2017;66:265–269.
3. Horton MJ. Before You Share That Pain Medication… addiction.com website. https://www.addiction.com/12040/before-you-share-that-pain-medication/. Accessed November 28, 2017.
4. Overdose Death Rates. National Institute on Drug Abuse website. https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates. Published September 2017. Accessed November 28, 2017.
5. Disposal of Unused Medicines: What You Should Know. Food and Drug Administration website. https://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm. Accessed November 28, 2017.
