The Wisdom of Restraining Opioid Use

"Is there any way to get a message to dentists that this is an overuse of medication? For getting wisdom teeth out, all you need is Tylenol, and it's foolish and irresponsible to give young people such powerful painkillers when they're getting their wisdom teeth out."
Conservative MP Terrence Young

"We know that people are receiving opioids after dental surgery and (we) are very interested in the overuse of these products. A big concern for me is once people get a prescription for these drugs, it is often an entry into using opioids." 
Tara Gomes, Scientist, Li Ka Shing Knowledge Institute, St. Michael's Hospital/Institute for Clinical Evaluation Sciences

Toronto scientist Tara Gomes calls opioids risky medications that can be effective but need to be used appropriately. Photo Sydney Helland/ICES

Dr. Gomes undertook a study on the severity of opioid use in Ontario; she found that opioid overdoses were responsible for one out of eight deaths among young adults between the ages of 25 and 34 in the province. Such deaths have been rapidly rising in recent years, according to the study. To 41.6 deaths per million in 2010 from 12.2 deaths per million in 1991. Researchers have been interested in "the dentistry question" relating to opioid prescription use for some time.

Typically, Dr. Gomes found prescriptions are written for more pills than the patient would require; just in case. The pills are left in medicine cabinets, and later occasionally are used and abused. Their use can cause accidental addiction when oxycodone is chewed, releasing all the active ingredients in the drug at once, rather than gradually, leading to a high.

Among high schools and university students, Dr. Gome's research disclosed that the recreational use of opioids is increasing. On occasion patients bring along leftover pills to schools or to parties they attend; a "potential entry point" for addiction, she states.

"Only in a minority of situations is an opioid required for any dental procedure", said Dr. David Mock, dean emeritus of the University of Toronto faculty of dentistry dental school, and a member of the national advisory council on prescription drug misuse, currently writing a new opioid policy for Ontario dentists.

Patients should be advised to use over-the-counter painkillers like acetaminophen or ibuprofen for mild to moderate pain, he pointed out. Codeine could alternately be prescribed, or oycodone, the ingredient in OxyContin and other drugs, but in low doses, over a short period of time, as long as the patient has been screened.

Obviously action should be taken to address the rash of addiction and deaths relating to opioids; a growing health crisis right across North America, in recent years.

Member of Parliament Terence Young, testifying before a parliamentary hearing late last year, spoke of hearing firsthand from a woman who operates a methadone clinic in his Oakville riding:

"She has young people coming to her clinic once or twice a week to get methadone who got addicted to OxyContin when they got their wisdom teeth out. Dentists -- not all of them, but some -- are using OxyContin and just giving them a bottle of pills when they get their wisdom teeth out, which, in my view, is beyond risky, it is reckless."

Dr. Mock acknowledges that the College of Dental Surgeons is aware of the situation and is moving to address it, attempting to handle the situation before it spirals further out of control. Prescriptions for opioids after dental surgery, he claims, have begun decreasing and will decrease further.