The Role of Dentists in the Growing Opioid Addiction Crisis

By Erin Delmore

For all the talk this week about doctors’ role in the state’s growing opioid addiction crisis, it’s dentists who introduce a huge percentage of young people to prescription painkillers.

State Sen. Joe Pennacchio said, “It’s not that opioids are bad, it’s the misuse of opioids that’s bad. And I’d hate to think on the one hand we are de-deamonizing the abusers and using the medical and dental professionals as scapegoats.”

Dentists are the fifth most frequent prescribers of opioid pain relievers, according to the U.S. Food and Drug Administration. They dole out the stuff for oral surgeries, like tooth extractions. According to research published in the Journal of the American Medical Association, 42 percent of dental patients filled a scrip for an opioid within seven days of a tooth extraction. Most were between the ages of 14 and 17. The second largest share of patients were 18 to 24 years old.

“Eighty percent of new heroin users started with prescription drugs. So, what will happen is the person becomes addicted to taking a prescription drug, they become a dependent, then when it becomes a little too expensive or their doctor no longer prescribes or they find it harder to get, they turn to heroin,” explained Drug Enforcement Administration of New Jersey Special Agent Carl Kotowski.

Pennacchio is a dentist. He says people in his profession are left to decide whether a patient can handle a heavy-hitting prescription painkiller based on few cues.

He said, “You size them up. You take a look at the patient. If the patient’s willing to undergo treatment, you’re more apt to write a prescription for an opioid. If the patient says no, I’ll come back, you’re less apt. You know, we haven’t done anything yet, you can’t get it. If the patient tells you what you want, you can’t treat them. It’s your license on the line.”

Anti-drug addiction groups have been working to steer medical professionals away from prescribing the stuff. But Pennaccio says, that’s commonly not an option.

“If somebody comes in and we’re prescribing a Vicodin and told we can’t, say, we’ll just give them a little Tylenol — unless they have a bad liver, then you can’t do that,” Pennaccio explained. “Or tell them to take a little Advil. Not if they have high blood pressure, you can’t. So don’t tell me what I can or can’t prescribe. Should we be looking into the non-essential users of the medicines and the over-prescriptions? Absolutely, but again, 99.9 percent of my profession is already looking into it themselves.”

Pennacchio says, patients are increasingly saying they don’t want a prescription for Vicodin or Percocet. A hopeful sign risk awareness is taking hold.