Let’s look at the numbers (I’m rounding a bit here for readability, but you can look at the exact numbers).
The researchers were looking at young people, 16 to 25 years old, who had health insurance in 2015. They looked at three quarters of a million young people.
Of those, 4% got an opioid prescription from a dental clinician in 2015, and 9% got an opioid prescription from another medical provider. These are young people: we’ve got to figure that the vast majority of prescriptions of opioids from dentists for teenagers and young adults are for wisdom teeth removal. Indeed, the article says as much: “dental opioid prescriptions, which may be driven by third molar extractions in this age group…”
The researchers randomly selected about half of the young people who had gotten dental opioids, and compared them to a randomly-selected group of about twice as big that had not gotten any opioids.
Now, here’s the awful news. I’ll quote so you can see yourself.
In other words, of those who got opioids from dentists, almost six percent ended up being seen by a health care provider for opioid abuse in the following year. That’s horrible, 1 in 17.
Of the young people who didn’t get opioids from dentists, about 0.4% got seen by health care providers for opioid abuse in a year. Even for kids who didn’t get opioids, four out of a thousand is a high number, maybe one kid per high school.
@TS0104 already pointed this out. I don’t know what dental procedure requires opioids 90+ days post surgery, but it’s safe to assume it most definitely was not wisdom teeth removal.
This may be true, but your conclusions don’t follow. It could be 93% of those people receive opioids for wisdom teeth removal and 0% of that group gets addicted. 7% receive opioids for chronic pain and almost all of that group gets addicted.
If your hypothesis is true, @roethlisburger, then every young person who got opioids from a dentist for something other than wisdom tooth removal got addicted. I don’t believe this and neither do you. Moreover, what is the chronic dental pain that young people would have had that necessitated opioid prescriptions from dentists?
It doesn’t say 7% of the young people who got an opioid prescription from a dental provider then got another prescription from the same provider. It says they got another prescription from someone. They could have gotten addicted and figured out how to wangle a prescription for their sports injury or for something else.
I think this undermines the credibility of the study even more. A kid gets their wisdom teeth removed and gets a four day prescription for that. Six months later they have a compound fracture in their leg or tear their acl and get opioids for that. I suppose the theory is if they never got opioids for wisdom teeth removal, they would be tough enough to get through their torn acl or broken leg on Advil.
My D recently went to the Dr for excruciating pain that was diagnosed as a untreated ear infection that went into her mastoid. The Dr was very concerned and ordered a CAT scan that same day. My D was given a prescription for a strong antibiotic and also for 40 Norco. I was shocked that a Dr would prescribe that amount of pain medicine for anyone. Her Dr gave her guidance on even trying something else first. My D was in intense pain and did take the meds for three days. The last day with just 1/2 tab. She had multiple people (not her MD) warning her to be very careful and to get off them as soon as possible. Both her fiancé and I commented on how we could tell when she had taken it. She definitely sounded high. We had some friends over for dinner the other night and we were talk No about the prescription. 2 of our guests were in recovery and said how they know so many people who ended up with a problem starting with a legal prescription.
I was very guarded of the pain meds when my kids had their teeth out. I remember with my S him telling me that kids at school told him hold great getting your wisdom teeth out was as you got to take Vicodin. I didn’t give him any and he shucked a few when I wasn’t looking. He called me from school with an intense stomach ache. Ends up he is like me and can’t tolerate pain meds.
Can’t tolerate what he took- and I don’t know if “shucked a few” means more than one at a time. Not necessarily tha he can’t tolerate any. That depends.
For severe pain, at 10mg per pill, taken every 6 hours, that’s 4/day. 20 pills would be 5 days. Ten days/40 pills shouldn’t be needed, for most dental. Many times, the dose is 5mg.
No one knows, in advance, if they have the receptors or some other physiological or psychological issue that would easily lead to dependence/addiction. But too many in an Rx is too many. And we can all talk to our kids about too much or we can manage these pills for them.
@roethlisburger , thanks for answering that about the 1 day time limit of prescriptions. That’s an interesting law. I can see how we don’t want prescriptions for pain meds floating around. And since I bet that many get their procedures done on the last open day of the office, so they can recover over the weekend, they would rather write one than deal with a phone call off hours.
Actually, I think the study should be read the opposite way. Of those who had opiod relief twice in 1 year, 95% did not become addicted. Those are fine odds to me.
@roethlisburger, I’m not following your argument here. Of the young people who got the opioids for some sort of dental issue, in the following year, almost six percent got some kind of treatment for opioid abuse. In my view, this is horrible.
First you tried to explain this away by saying it could have been the young people who got dental treatment for some other issue that got addicted, but the people who got opioids didn’t addicted. This has two problems. It seems unlikely to me that so many young people have dental problems that are not wisdom teeth and that are thought to require opioids. Moreover, if there were so many young people who had non-wisdom-tooth dental problems, and almost all of them who were prescribed opioids ended up addicted, that would still be terrible and would be an appalling indictment of dentists. What, you’re saying that dentists give opioids to young people with non-wisdom-tooth pain, and all of them get addicted, and the dentists didn’t notice or didn’t care? That strains credibility.
Now you’re saying… what are you saying? The problem here is not the people getting two opioid prescriptions in a year. The problem is the 6 in 100 young people getting one opioid prescription and subsequently getting addicted that year, whether because of that first prescription, or possibly because of a second prescription. We don’t know how many of the people who got two prescriptions got addicted. They might overlap totally or not very much.
That is NOT what the study says!!! It says 94% of those who got opioid relief ONCE in a year did not get addicted, and the other ~6% did get addicted. If that sounds like fine odds to you, you have a very different tolerance for risk than I do.
Actually, even if you were right, I still wouldn’t think those were fine odds. If I’m the parent of the kid who is about to get the second opioid prescription, and the doctor says, “Here, take this script. There’s only a 6% chance that your kid will get addicted from this prescription or is already addicted!” I would think hard before I filled it. Those odds are way too high for me.
Most side effects of any Rx are listed when far les than 6% are potentially affected.
Of course, when there’s some loopy side effect possible that you’ve never had any issue with, you make an educated decision. If 2% have, say, dizziness, I’ll be on the alert for that.
But this tendency to dismiss addiction issues because it’s only 6/100 seems like playing with fire. No one is insisting opiods are never needed, But in excess? No.
Who decides what is in excess? And it is quite possible that the 95% who did not have opioid issues after having 2 prescriptions in a 1 year period were self medicating with other things, like weed or cocaine, or were just generally healthier than the nonaddicted group. I am confident in my family’s ability to stay within the 95%, and, I wish to avoid pain. If you choose differently, so be it.
People whose kids have problems, like addiction or failure in school, are reluctant to post here, but they exist. In a previous thread on CC about addiction, a mom chimed in with a story about her son’s addiction that was as difficult and sad as you’d think. Her family didn’t have a history of addiction, but her son got opioids for, if I recall correctly, a sports injury, and subsequently became addicted. When the kid had the injury and took the opioids, she didn’t expect him to become a drug addict, but he did.
All this is to say, it happens. It happens to people like you and me. People like you and me have children who become addicted to opioids. We can say, “It’s not going to happen to my kid” (on what basis, exactly?) but some of us who say that are going to wake up and find out our kid is an addict.
That is the problem. There is no realistic way for a third party to know how much is “enough”, or even if any is needed. Nor is there any realistic way to know a given patient’s risk of addiction for the majority of young patients who have not previously used opioids before wisdom tooth surgery (for the few who have, the previous outcome may be helpful here, though it seems that some prescribers ignore previous patient history, as described in reply #2).
It does seem like most prescribers prescribe on the high end of the range “just in case”, resulting in leftovers even if the patient does not become addicted, with such leftovers becoming a risk if acquired by others with addictive tendencies. Of course, prescribing more than enough (leading to leftovers, whether they are later used recreationally or disposed of properly) also means more profits for the drug companies pushing the opioids.
How many people feel that they did not get enough opioids in the prescription, or feel that they needed them but did not get them, for something like a wisdom tooth extraction or comparable oral surgery?
If you are so concerned about the risk, don’t accept or fill the prescription. No one is forcing these pills down an unwilling throat. But there are some who both need and want pain relief in this form.
@roycroftmom, you’d be giving me excellent advice, in case I didn’t care about anyone but myself and my own family. If I didn’t care that some innocent family is unwittingly taking a huge risk of addiction, if I didn’t care that addiction is killing twice as many people as cars, if I didn’t care that addiction is straining city and state budgets and causing heartbreak all across the country, then I could follow your advice and do nothing else. But I care about public health.
It is no surprise that there are people think us of opiods OK for minor procedures like a teen wisdom tooth extraction. This is why there is a problem. People want those meds and it is easy peasy to get them. The real point is that there is money to be made in this madness and the insurance companies must love rehab stats being so ineffective. Users of this option believe this is about exercising free choice in the market place. There is no such thing as bad publicity for people who like drugs.
Sue22 I agree 100%. It’s my understanding that mouths heal very quickly. The vast majority of people tend not to walk around with gaping holes, infections, dry sockets, for 20,30, 60…365 days(???) after having their wisdom teeth removed, (or even other common dental procedures done (eg implants, gum surgery, root canals, etc). It wouldn’t surprise me that some/many patients are either already abusing drugs prior to their wisdom tooth extractions and continue to feign pain to continue their abuse, or they have a market to sell these drugs, recreational use with friends,etc. I also note that the articles say the use of opiates “may” be connected with abuse. May does not equal will become addicted. Yes the numbers in article raise an issue, but in and of itself, I’m saying the leap from having wisdom teeth removed to drug addiction is not necessarily a straight line, or be willing to believe that accepting and using opiates is a “significant addiction risk” without more background info about each patient.
post#20
Perhaps instead of checking this connection, one would be better served to find another MD/DDS and get a second opinion and/or a more accurate diagnosis/treatment option.