On Reddit, protected by a cloak of anonymity, users ask for tips and tricks on how to obtain more painkillers. “Just had my wisdom teeth taken out,” reads one post. “Got prescribed 28 [Percocet pills]. They’re about to run out. Not only does my mouth still hurt, but I like [the pills].” The user then asks what he can say to his dentist to persuade him to refill the prescription.
Wisdom teeth extraction is so incredibly common and so are the post-op opioids. Have we accidentally created a gateway to addiction? Some experts believe so. 5 million people undergo wisdom teeth extractions every year. This surgery is typically performed on young adults, ages 16 – 25. In 2018, a study from Stanford Medicine found that dentists are the leading source of opioid prescriptions in young adults. The same study found that patients who were prescribed opioids after extraction were more likely to keep up the habit than peers who went drug-free.
The evidence is clear. A University of Michigan research team found that post-extraction, “the accompanying opioid painkiller prescriptions…can lay a foundation for long-term opioid use.” A study published in the scientific journal Pediatrics concludes that opioid use after an extraction makes a young adult 33% more likely to abuse opioids. Yet, painkillers are still commonly prescribed after dental surgery.
A question must be considered: are opiates necessary post-extraction? The short answer is probably not. As a general procedure, prescriptions are given out indiscriminately after wisdom tooth extractions. Patients are often told to “stay on top of the pain” and keep taking the medication around the clock. Everyone has different pain tolerances, but more often than not, a wisdom tooth recovery can be managed with OTC pain relievers like Advil or Tylenol. In fact, a study published in the Journal of the American Dental Association found most patients experienced relief with a combination of acetaminophen and ibuprofen, no opioids necessary.
There’s no harm in prescribing painkillers just in case though, right? Wrong. There’s a risk to prescribing painkillers, even if the patient doesn’t use them in the end. Leftover drugs are a serious problem. Sitting in my medicine cabinet right now are numerous unfinished prescriptions. There’s a bottle that contains expired painkillers from a shoulder injury. There are only two tablets missing because I didn’t end up needing the drug by the second day. Keeping that bottle is wildly irresponsible of me. Still, I guarantee you have a stash of leftover prescriptions in your cabinet as well. A study from the University of Pennsylvania’s Perelman School of Medicine and School of Dental Medicine found that, on average, patients were prescribed 28 pills after wisdom teeth extractions. Most discontinued use after a few days, leaving about 15 potent and addictive pills in their medicine cabinets. If we multiply those remaining 15 pills by the average 5 million extractions a year, then our nation’s opioid epidemic begins to make more sense.
In these medicine cabinets, experts speculate, is where many addictions begin. After all, it’s easy for a teenager to access some opioids if their parents never finish their prescriptions. A pill is easier to attain than a bottle of liquor. Most people lock their liquor cabinets, after all. No one locks a medicine cabinet. According to the U.S. Department of Health, 66% of teens that abuse prescription medications got the drugs from friends or family. Almost 80% of recreational opioid users will eventually move on to something stronger, like heroin.
When it comes to the opioid crisis, there is plenty of bad news to go around. Yet, there is a bit of good news. Awareness campaigns do work. Yes, all those “dispose of your medications!” billboards you pass every day are doing their job. The numbers don’t lie. When people are given information about safe drug disposal, they end up doing it. That’s great news because it keeps pills out of the wrong hands, but there are other benefits, like a decrease of flushed medications contaminating our water supply. Safer water is a win for everyone.
As for wisdom teeth extractions and opioids, the answer is clear. Opioid prescriptions after a wisdom tooth extraction should be a last resort. Pain rarely lasts past a few days post-op. Discomfort and swelling can be managed with Tylenol or Ibuprofen. Some people will need a strong painkiller and that’s reasonable. Dry socket or infection pain shouldn’t be suffered through needlessly. Still, the dentist should wait to scribble on that prescription pad until the patient shows a need. We need to end the practice of giving away prescriptions like post-procedure goodie bags. It isn’t all on the dentists though. We as patients need to take responsibility. We can do this by only accepting opioid prescriptions when absolutely necessary and by disposing of leftover medications safely. We can all take steps to prevent prescription drug misuse.
April 27th is 2019’s National Prescription Drug Take Back Day. This yearly event offers the opportunity to safely dispose of your prescriptions, no questions asked. Please visit the event’s official website to find a collection location near you. If you missed the big day, you can find a year-round safe disposal location on the Drug Enforcement Agency’s website.