Dentistry and the Opioid Epidemic

August 16, 2017 3:44 pm Published by Leave your thoughts

 

In the United States, drug overdose is the leading cause of injury-related death.

Let’s be honest—pain medication is one of the best things that ever happened to dentistry. Prior to effective pain management, dental work was rather uncomfortable, to say the least. However, we have now reached the other side, and our society faces the serious issue of a population that has a hankering for prescription pain medications.

For the last two years, deaths due opioid overdose have surpassed deaths caused by firearms and even car accidents. Over half of those deaths were directly related to prescribed medication, and it’s safe to bet that a good portion of the rest began with prescribed medication until things escalated.

Should dentists evaluate their recommendations of narcotic analgesics for pain management? At the very least, doctors should work to keep their patients educated and informed to protect both them and their families. They should also be on the lookout for patients who may have an issue with opioid addiction.

Opioid infographic

What to Look For

We had a new patient come in on short notice. He declared tooth pain, and he brought in his own x-ray from another doctor. As this raised red flags, he was offered a free x-ray to ensure the accuracy of the diagnosis, and it was then that the patient bolted. This doctor called the local pharmacist to give them a heads up, and they in turn notified other dentists that this young man was shopping around for some Percocet.

Telling the difference between a legitimate patient and a drug abuser isn’t easy. The drug-seeking individual may be a stranger. They could be a person who claims to be from out of town and has lost or forgotten a prescription medication. Or the drug seeker may instead be someone familiar to you, such as another practitioner, co-worker, friend, or relative. Either way, drug abusers, or “doctor shoppers,” often share similar traits and modus operandi. Recognizing these characterics is the first step to identifying the drug-seeking patient who may be attempting to manipulate you in order to obtain desired medications.

Common Characteristics of the Drug Abuser

  • Unusual behavior in the waiting room
  • Assertive personality, often demanding immediate action
  • Unusual appearance—extremes of either slovenliness or being over-dressed
  • Unusual knowledge of controlled substances
  • Generally has no interest in diagnosis—fails to keep appointments for further diagnostic tests or refuses to see another practitioner for consultation
  • Exaggerates medical problems and/or simulates symptoms
  • Mood disturbances, suicidal thoughts, thought disorders, sexual dysfunction, and/or lack of impulse control
  • Cutaneous signs of drug abuse—skin tracks and related scars on the neck, axilla, forearm, wrist, foot, and ankle. Such marks are usually multiple, hyperpigmented, and linear. New lesions may be inflamed. Shows signs of “pop” scars from subcutaneous injections.

Modus Operandi Often Used by the Drug-Seeking Patient

  • Must be seen right away
  • Wants an appointment toward the end of office hours
  • Calls or comes in after regular hours
  • States he or she is traveling through town or visiting friends or relatives (not a permanent resident)
  • Gives medical history with textbook symptoms, or gives evasive or vague answers to questions regarding medical history
  • Feigns physical problems such as abdominal or back pain, kidney stone, or migraine headache in an effort to obtain narcotic drugs
  • Feigns psychological problems such as anxiety, insomnia, fatigue, or depression in an effort to obtain stimulants or depressants
  • Requests a specific controlled drug and is reluctant to try a different drug. States that specific non-narcotic analgesics do not work or that he or she is allergic to them.
  • Reluctant or unwilling to provide reference information. Claims to be a patient of a practitioner who is currently unavailable, or claims not to have a regular doctor. Often has no health insurance.
  • States that a prescription has been lost or stolen and needs replacing
  • Deceives the practitioner, such as by requesting refills more often than originally prescribed
  • Pressures the practitioner by eliciting sympathy or guilt or by direct threats
  • Utilizes a child or an elderly person when seeking methylphenidate or pain medication

What You Should Do When Confronted by a Suspected Drug Abuser

DO:

  • Perform a thorough examination appropriate to the condition.
  • Document examination results and questions you asked the patient.
  • Request picture ID, or other ID and Social Security number. Photocopy these documents and include them in the patient’s record.
  • Call a previous practitioner, pharmacist, or hospital to confirm the patient’s story.
  • Confirm the patient’s telephone number, if provided.
  • Confirm the patient’s current address at each visit.
  • Write prescriptions for limited quantities.

DON’T:

  • Don’t “take their word for it” when you are suspicious.
  • Don’t dispense drugs just to get rid of drug-seeking patients.
  • Don’t prescribe, dispense, or administer controlled substances outside the scope of your professional practice or in the absence of a formal practitioner-patient relationship.

Most opioid users began with a legitimate use of prescribed medication to treat real pain. We shouldn’t demonize those who have become addicted; they need help.

While it’s not a dentist’s job to treat opioid addiction, we can all do our part to prevent it from happening in the first place.

 

~Linda O’Grady

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