On October 26, 2017, the Department of Health and Human Services declared opiate abuse and addiction a public health crisis. In the United States alone, as of March 2018, approximately 115 people die every day as a result of an opiate overdose. Oftentimes, this addiction begins at a dental office with a legitimate prescription for an opiate painkiller following a dental procedure. In fact, dentists prescribe approximately 11 percent of prescription opiates annually.

Opiate painkiller prescriptions really came to the forefront of the dental industry in 1996, when a company called Purdue Pharma introduced a drug called OxyContin, coupled with a huge marketing push. Sadly, this marketing technique included the claim that the drug was non-addictive, which turned out to be false. In fact, in 2007 the company paid out one of the largest fines ever imposed on a pharmaceutical firm for this mislabeling. Three of the company’s top executives were also found guilty of criminal charges. Sadly, this lawsuit did not deter doctors and dentists from prescribing the drug, and patients from taking it. According to the Centers for Disease Control and Prevention, since 1999, the number of prescription opiates in the United States has nearly quadrupled. Not surprisingly, the number of deaths from prescription opiates has more than quadrupled.

When a patient takes a prescribed opiate following a dental procedure, the opiate triggers the release of endorphins, which is how the body experiences pleasure. It also blocks the receptors that cause the body to feel pain, creating a powerful sense of well-being. However, if taken for a long period of time, a person can build up a tolerance to the drug, meaning in order to get the same pleasurable effect, a higher dosage must be taken. This leads to an opiate painkiller addiction.

The problem with this handy but dangerous medication is that opiate painkillers are highly addictive, which can quickly transform a patient who is simply following doctors orders into an opiate addict. David Bell, CEO of USA Mobile Drug Testing, explains:

“Even when a patient is following their doctor’s prescription to the letter, they can become addicted to opiates because the longer they take it, the greater tolerance they will build up to the drug, thus requiring a higher dose to achieve the same results. That fact, coupled with the physical and psychological feelings it produces make it especially prone to abuse.”

An opiate addiction does more than affect the patient, it affects the entire community. The Centers for Disease Control and Prevention has estimated that in the United States, opiate misuse and abuse costs the country approximately $78.5 billion annually. In addition to the cost of healthcare and addiction treatment, the loss of productivity at work is factored into this figure. The problem has become so widespread that even the Department of Transportation has taken steps to update their DOT drug testing regulations.

Because people of every industry visit the dentist, every industry can be impacted by an opiate painkiller addiction. Employers and supervisors should take care to watch for the signs and symptoms of an opiate addiction to help ensure it does not negatively impact the workplace. Some of the symptoms of an opiate addiction include: marked changes in personality, from extreme euphoria to extreme drowsiness, confusion, constricted pupils, and loss of consciousness.

Bell notes that if an employer suspects that an employee is under the influence of opiates, that employee should immediately be relieved of all duties until a reasonable suspicion drug test can be given. This means that the employer has observed behavior in an employee that indicates he or she is under the influence of a drug or alcohol. The employee should not be allowed to return to work unless the drug test results are negative. This helps ensure that the employee does not cause an accident or injury, and it protects the employer from liability as well. If an accident does occur at work and the employer suspects it was caused due to drug use on the employee’s part, a post accident drug test may be administered. Should this drug test come back positive, it again protects the employer from liability. It also may affect the employee’s ability to receive workers’ compensation, should he or she be terminated after the accident and subsequent drug test.

As a way to help combat the opiate crisis, the American Dental Association (ADA) has tried to educate its members and encourage them to turn to non-narcotics as the first remedy for dental pain following a procedure. Also, in March 2018, the ADA announced a new policy that would limit opiate prescriptions to no more than a week if it is determined that a stronger medication is needed, The dentist needs to exhibit strong caution before an opiate painkiller is prescribed, and he or she should have a conversation with the patient regarding his or her medical history, and to help ensure that the patient does not have an addiction problem. Additionally, the dentist should make sure the patient understands the potential dangers of opiate abuse.

Dr. Melissa Goodpaster of Cherry Creek Dental Spa explains “We recommend that patients with addiction problems enter treatment before getting extensive dental work completed. This can be especially important because combinations of opiate drugs, nitrous oxide and anesthesia can be very dangerous.”

This is especially important if the patient is a teenager. Although an over-the-counter painkiller would have been sufficient following a routine dental treatment, such as a tooth extraction, 61 percent of teenagers were given a prescription of opiates. This, coupled with that fact that as of 2015, more than 276,000 adolescents were using opiate painkillers for non-medical reasons, and almost half of them were addicted. In 2018, Pennsylvania enacted a law that requires written parental consent before a dentist can prescribe an opiate painkiller to a patient under the age of 18.

Dental patients who have taken opiate painkillers regularly for longer than one week are highly likely to develop some degree of dependence on the drug, possibly even an addiction. Should this occur, a gradual tapering of the dosage may be required to help avoid withdrawal symptoms.

“People who have abused opiates for an extended period of time could run the risk of putting their life in danger if they choose to quit cold-turkey. However, the risk of seizures along with significant psychological symptoms resulting from opiate withdrawal can be significantly reduced by undergoing medical detox in a certified opiate rehab.” explains Matthew Boyle, COO of Landmark Recovery

Withdrawal from opiates can be a painful process, and symptoms include anxiety, insomnia, profuse sweating, abdominal cramping, muscle aches and pains, nausea, and vomiting. Because of this, it is essential that patients seek medical professionals to help them go through the withdrawal process. Treatment facilities that specialize in opiate addiction exist nationwide. These professionals will not only offer patients the emotional support needed to combat addictions, they will be able to tailor a treatment plan according to the patient’s specific needed. These plans often include additional medications, group therapy, and a healthy diet and exercise.