Recently, the American Food and Drug Administration launched new page for
consumers who would like to know more about the implications of taking
opioid painkillers.
In addition to opioid-related questions which patients may ask their
medical practitioners,
the new page
also contains tips on how to store and dispose of these medicines.
Worldwide, dentists are encouraged to discuss with their patients, the
dangers of using opioid painkillers for non-medical use.
The British Dental Association offers free advisory help to members and
non-members, covering issues such as the latest techniques for identifying
patients who need painkillers for non-medical use. There are also tips on
how to briefly counsel such patients and refer them to the appropriate
substance abuse treatment experts.
For information on standards of conscious use of sedation in dental care,
please
refer to this document.
If you have currently have patients who use opioids for medical purposes,
here are some things you should know.
Know the patient’s personal history of opioid use
This is the strongest risk factor for opioid users; their personal history
with the drug or other substance. A family history of substance abuse is an
indicative factor of high risk of addiction. Psychological issues such as
depression and similar comorbidities are another risk factor.
Another high-risk indicator of abuse are people between the ages of 20 and
40 years, and women who have a history of sexual abuse in their
preadolescent years. In some studies,
somatization was proven to be a risk factor too. Before starting an opioid
prescription, endeavour to find out more about your patient’s history.
Opioids impact concentration levels of drivers
The use of opioids can decrease cognition and slow reflexes. Concentration
levels are also affected, especially when first started or changing doses.
Although some people who have been on a stable dose may not show any
driving difficulties.
Patients should be counselled on the possible dangers of opioids on
concentration levels when driving. They should also be advised not to drive
when they feel impaired. Dr. Neil Oza of Advanced Dental Concepts
says, “If you are administering opioids to patients for the first time or
changing their dosage, remind them to avoid driving for a while.”
The use of combined opioids
While some dentists choose to increase the dosage of a particular opioid
prescription, others may administer a combination of two opioids. This is
understandable when you know that some patients benefit from a single
opioid use, while others experience better relief when a specific opioid is
applied as a long-acting agent and a different one is applied for pain that
breaks through this regimen.
It is not unusual to find this practiced among some professionals because
some studies have shown that such combinations may improve the outcome.
Watch out for opioid shoppers
Dentists should be wary of certain patients who show up under the guise of
help from pain. Most times, they are merely shopping for new opioids to
abuse. It is easy to identify such individuals if you are used to them.
However, not everybody can tell the real from the impostors.
Managing opioid abusers can often be seen as a daunting task. It is
advisable to first listen to the patient and establish a genuine need for
dental care, otherwise, you may refer them to a substance abuse expert. Do
make sure you are thorough about their need for treatment before making
further suggestions.
Opioid abuse remains one of the major problems of addiction in the UK, it
is therefore important to advise user carefully. If you need further
clarification, contact your local association.