In July, a group of state attorneys general announced an agreement with drugmaker Johnson & Johnson and 3 of the nation’s largest pharmaceutical distributors to resolve claims that their actions have contributed to increasing the opioid epidemic. . The numerous lawsuits accused the distributors – McKesson, Cardinal Health and AmerisourceBergen – of facilitating the flow of massive amounts of opioids to communities and Johnson & Johnson of misleading opioid advertising. The companies denied any wrongdoing.
Meanwhile, the opioid crisis continues. According to the Centers for Disease Control and Prevention (CDC), overdose deaths reached record levels at 2020, a 31% more than the previous year.
A surprising source of these drugs is the dentist.
According to a recent study published in the American Journal of Preventive Medicine, overdose rates were 2 ½ times higher higher in people who filled an opioid prescription after a dental procedure than in those who did not.
Researchers at the University of Michigan analyzed the medical records of adolescents and adults who underwent a dental procedure, such as the extraction of wisdom teeth, between 2011 and 2018. Of the 8.5 million procedures analyzed, in almost 27% of cases , patients filled a prescription for an opioid such as Vicodin or Oxycontin.
In this group, the overdose rate was 5.8 for each 10, 000 patients, compared to 2.2 for each 10, 000 procedures between patients who did not fill an opioid prescription.
Overdose rates were also higher among family members of those who filled an opioid prescription, based on the team’s independent analysis of approximately 3.5 medical records .
The study authors estimate that if dentists did not prescribe opioids, in the United States there would be 1, 700 fewer overdoses each year.
Opioid prescriptions by dentists have decreased dramatically in the last 2 decades, including in the 3 years since the most recent data recent studies from the University of Michigan study, says Raymond Dionne, PhD, member of the Council on Scientific Affairs of the American Dental Association. “20 years ago, around 15% of all opioid prescriptions in the United States were written by dentists, ”he says. . “Now it comes down to maybe a third of that.”
However, Dionne, who specializes in pain research, says there is still room for improvement.
The good news is that dentists can recommend safer ways to relieve pain. A body of research has shown that for most people, over-the-counter pain relievers have the same or even better results than opioids, with far fewer side effects.
Too many side effects; too little relief
It’s a myth that opioid pain relievers are more powerful than over-the-counter products, says Dionne. “People may feel like they are not getting the most powerful pain reliever if they are not getting something with an opioid, but it may be the opposite,” he says.
Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin IB and generic) and naproxen (Aleve and generic) work particularly well against dental pain because they block the enzyme that causes the gums to become red and inflamed, says Paul A. Moore, PhD, professor from the University of Pittsburgh School of Dental Medicine. Acetaminophen (Tylenol and generic) works through a different mechanism to reduce pain perception, he says.
Combining NSAIDs with acetaminophen has good results even for the relief of moderate to severe pain in people who have had their wisdom teeth removed; in fact, it is better than an opioid for most people. This is based on a comprehensive review of research by Moore and colleagues published in the Journal of the American Dental Association at 2018.
Another advantage of over-the-counter pain relievers is that they generally cause far fewer side effects than narcotic pain medications. It is common for prescription opioids to cause nausea, constipation, drowsiness, and a feeling of confusion. In addition, taking the medications for longer or in higher doses carries more serious risks, including addiction, overdose and even death.
How to make a plan to relieve dental pain
People undergoing any type of dental surgery should ask what treatments are available and communicate their preferences for pain control when making a plan with their dentist or oral surgeon, he says Dionne.
Make sure to give your complete medical history to the doctor so they can recommend the painkillers that are safest for you. For example, most people who take blood thinners or have advanced kidney disease should avoid taking an NSAID.
It is important to know that it is not safe to take too much of any type of medication, including over-the-counter products. So, get written instructions on how much of each type of medication to take and how often to take it.
Start by taking steps to reduce your dental pain immediately after your procedure, which it’s when it’s most likely to be most intense, says Dionne.
For example, your dentist may use long-acting anesthesia to make the feeling of numbness last longer and may inject steroids into your gums to reduce swelling. You can put cold compresses on when you get home, and you can also take an NSAID before the anesthesia wears off to start controlling the inflammation as soon as possible.
After that, our experts advise customizing your treatment according to the intensity of the pain, adjusting the dose of your medication as the pain decreases.
For mild pain, an NSAID is usually sufficient, says Moore. Your dentist may recommend taking a higher dose at first, 600 mg of ibuprofen instead of the 200 mg a 400 mg standard, but never exceed the doses indicated on the label without approval from your provider.
If you need more relief, you can add from 325 mg to 500 mg of acetaminophen (one pill of regular or extra strength Tylenol).
The new over-the-counter pain reliever Advil Dual Action combines acetaminophen and ibuprofen, a convenient formula that can work against the mildest pain. “The ibuprofen and acetaminophen doses found in Advil Dual Action have been shown to provide safe and effective pain relief after minor dental surgery and simple tooth extractions,” says Moore.
However, Moore adds, the lower doses of pain relievers in this new product may be inappropriate for some patients with severe pain. “Higher doses of ibuprofen and acetaminophen may be appropriate for more complex and traumatic oral surgical procedures, such as the removal of multiple impacted wisdom teeth.”
Do not accept more opioids than what is needed
For severe pain, which usually arises from more intensive procedures such as bone removal, taking an opioid may provide additional relief if over-the-counter pain relievers are not enough says Dionne. In that case, your dentist should only prescribe enough for the first 2-3 days after the procedure. After that, you should be able to comfortably switch to other forms of pain relief.
Most dentists prescribe medications such as Percocet, Tylenol with codeine (Tylenol No.3), and Vicodin, all of which combine a low dose of an opioid with acetaminophen in one medication. Your dentist may recommend that you also take an NSAID to treat inflammation. But never combine a prescription drug that contains acetaminophen with an over-the-counter product that also contains it, including pain relievers like Tylenol and many cough and cold medications. Doubling the dose of acetaminophen can damage the liver and can be fatal.
If you have leftovers
Do not store them, especially the opioids. Many pharmacies, hospitals, clinics, narcotic treatment programs, and long-term care facilities will receive leftover and expired medications. For example, both Walgreens and CVS have installed self-service kiosks in many of their stores where you can safely dispose of medications.
To find an authorized drug take-back program near you, use the online search tool maintained by the Drug Control Administration. Or, you can call the DEA Registration Call Center at 800 – – 9539.
Additionally, many retail and mail order pharmacies offer free kits that allow you to safely dispose of medications at home. For example, DisposeRx, a packet of powder that, when mixed with water in a medicine bottle, turns medicines into a thick gel that is safe to throw away. You can also buy similar products online.
Read more about how to dispose of expired or unused medications.
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Consumer Reports has no financial relationship with the advertisers on this site. Consumer Reports is an independent nonprofit organization that works with consumers to create a just, safe, and healthy world. CR does not endorse products or services and does not accept advertising. Copyright © 2021, Consumer Reports, Inc.