Opioid Information and Facts
Often we see news stories on tragic deaths or ruined lives of young and middle aged people as a result of narcotic overdose and addiction. Our first thought is it was a result of intravenous heroin use or “shooting up”. But the fact is 3/4 of the deaths are from pain pills prescribed by well-meaning physicians, dentists, and surgeons.
As an oral and maxillofacial surgeon we are the #1 writer of opioid drug prescriptions for patients under 19 years of age in the USA. We are the #2 writer for patients 20 to 40 years old. In 2015, the Journal of Pediatrics’, reported, “legitimate opioid use before high school graduation is independently associated with a 33% increase in the risk of future misuse after high school.” The USA population is 5% of the world’s population, but we write 80% of the world’s oxycodone (Percodan/Percocet) prescriptions and 99% of the world’s hydrocodone (Vicodin, Lortab, Norco) prescriptions.
There is a role for opioid medications. These drugs are needed to humanely treat patients in pain, but now we have the difficult task of balancing pain relief with the need to prevent adverse outcomes for our patients. Every day in the USA 60 people die from an opioid overdose, 44 from prescriptions written by doctors and 16 from illicit use. Most addicts started with prescription opioids for medical/dental purposes but due to the reluctance of doctors to keep prescribing the drugs and the high cost of these drugs on the street they seek the ready availability and lower cost of street drugs.
We appeal to you to join us in controlling this epidemic by responsibly using these medications as prescribed and once you are free of pain to dispose of them properly. Statistics show the source of most street pills are not from dealers but are removed from patient’s medicine cabinets, legitimately prescribed by their doctors.
Multimodal Pain Management
What does this mean? The concept of taking one pain pill does not satisfactorily help all patients. Pain is a complex subject, extremely variable between patients, and control of inflammation and blocking of neural pathways is the most effective strategy. The combination of pre-operative over the counter (OTC) non-steroidal anti-inflammatory drugs (NSAID’s) along with post-operative prescription medications as needed and local anesthetics is termed multimodal pain management.
Our Recommended Pain Control Strategy
(Patients with diagnosed kidney or liver disease will be advised differently)
- The day before surgery start taking OTC ibuprofen 400 mg (2 tablets Advil ™, Motrin ™) every 6 hours. For patients prone to stomach irritation with NSAIDS please find an enteric coated version to minimize these adverse effects.
- The day of your procedure continue the ibuprofen and add 325 to 500 mg acetaminophen (Tylenol™) every 6 hours. (2 ibuprofen + 1 acetaminophen every 6 hours).
- Local anesthetics lasting 6 to 8 hours are given for local pain control during your surgery. Bupivacaine liposome (Exparel™) is a long lasting local anesthetic lasting as long as 2 to 3 days. This option is available for additional fee and will be discussed with you at the time of your exam.
- For break through pain, you may add your prescribed pain reliever. Take as directed on your prescription bottle as to how many and how often. Many patients who follow the above regimen find they need little or none of the prescription. This avoids common complications associated with opioids, which include nausea/vomiting, itching, constipation, respiratory depression, increasing tolerance and dependence, and addiction risk. If you were prescribed a narcotic medication with acetaminophen (Tylenol with codeine ™, Lortab™, Lorcet™, Vicodin™, Norco™, Percocet™, others) stop taking the OTC acetaminophen but continue the OTC ibuprofen.
- Typical dental surgical discomfort lasts 2 to 3 days, so continue your ibuprofen and acetaminophen regimen for this duration.