Rinse – Spit – Hysterics by Pat Conrad MD
One of my memories from the summer of 1977 was falling asleep in the dentist chair, and then being helped down the stairs awhile later, wisdom teeth gone. Soup and pudding for a couple of days, chubby cheeks for a week, and it was all forgotten. And of course I had all those opioids left over…
An article on the MSN website is encouraging us to get hysterical about dental procedures as a source of opioid diversion. The “How Wisdom Teeth are Fueling the Opioid Epidemic” begins with a CDC figure of 33,000 deaths in 2015 due to opioids, half of which were due to prescription opioids. Then the author cites a study from “Drug and Alcohol Dependence” – no agenda there! – stating that, “more than half of the opioid painkillers prescribed to patients after wisdom tooth removal surgery went unused.” The conclusion of this study of 79 patients (and 3 oral surgeons) determined that, “If those numbers were to play out for all practicing oral surgeons, that would translate to a startling annual figure: 100 million opioid pills, prescribed for wisdom-tooth extraction, go unused.” On average, each of these 79 patients received 20 opioid pills, 54% of which went unused.
Oh here we go: “Still, the study highlights the need for policymakers to broaden the availability of drug-disposal sites at pharmacies and other places people routinely visit, possibly also with small financial incentives.” Yes, the pharmacy even experimented with a buyback program, 20 cents of store credit per pill. So you could lug your achy-jawed self down to the local pill shop and get two bucks and change toward that heart-shaped Reese’s cup you were lusting after when you first picked up the pills.
Questions, questions: who the hell would bother funding such a ridiculous, small-n study, and for that matter who would fund “Drug and Alcohol Dependence”? And why would anyone think that a “pharmacy disposal program” would ever be useful or used, when presumably all of these patients’ homes have working toilets? Of course the recently de-wisdomed are going to save the pills for another emergency, a bribe to a teenager, or for a boring Friday night. I’d like to wonder whether 28 pain pills is a bit much – wouldn’t 15 do – but it’s hardly extravagant. No, this is just more in the vein of do-gooder opinions dressed up as science, with shadowy funding, all trying to homogenize the art of medicine and keep doctors (and dentists) in line.
…actually I don’t recall getting any opioids after my procedure back in 1977, but I wish to hell I had. I could’ve traded them for beer.
I agree with Sir Lance-a lot. In addition I have had my wisdom teeth removed. I have a very high pain threshold (walking around less than 24 hrs after having an iliac crest graft for a cervical fusion). The 3rd molar extractions were much more painful so I did need opioids. It was better to have a few too many tablets than to run out and need more in the middle of the night or on a week-end.
Too many ‘know it alls’ try to dictate the individual practices.
As a patient, I would much rather have a few too many Percocet than a few too few.
Prescribing #90 for a person who’s likely to need #12 is obviously a Bad Idea, if you prescribe #20 and he’s left with 8 extras, that’s not going to send him or anyone in his family into a drug fueled orgy of self destruction.
These anti-drug assholes are just as much assholes as the “Pain Scale” pro-drug assholes of 15 years ago.
Maybe just actually treating your actual patient would be a good idea, huh?