Pain and Drug Abuse from an Oral Surgeons Point of View

As health care professionals, we have been engrained to care for basic human needs especially the relief of pain and suffering. Oral surgery being a branch of the dental profession, has been a part of the stigma which characterizes pain as a synonym for a dental office visit.

Through the years, the dental profession as well as oral surgery has embraced advances in technology, anesthesia and medication in order to reduce stress and increase the comfort level of the patient population. In the mid 1990’s the pharmaceutical industry came up with what they thought was the magic bullet for post-operative pain, opioid and opioid derivatives. This family of drugs was prescribed inordinately by both the medical and dental profession, typically post-operative pain in the oral surgery setting. The professionals prescribed the medications with the reassurance of the pharmaceutical industry that these drugs were not addicting. Unfortunately, this assertion was the straw that broke the camel’s back resulting in misprescribing and drug over use. Adolescents became the target and resulted in the increasing drug abuse problem.

The use of opioids as a post-operative pain reliever has admittedly been the start of what became known as an obsession and addiction. The literature shows that 2 out of 10 adolescents first time opioid involvement was the result of a post-operative prescription. The prescription led to an experience or state of ecstasy which then was constantly pursued by the adolescent and progressed into long term drug seeking. Due to the endemic proportion of drug abuse (mostly from prescribed medications), the American Society of Oral Maxillofacial Surgeons drafted a white paper advocating that the use of opioid post-operative pain medication be placed in the archives of the oral surgeon’s formulary. Medical literature has shown that nonsteroidal and acetaminophen are more effective in allying post-operative pain than opioids with the benefit of less side effects. This has become the standard of care in our office setting with very satisfying patient results. Hopefully we are doing our part to help fight drug abuse and keep our young adults free of the shackles of opioid addiction.