The Dentist’s Office Must Not Be a Gateway to Opioid Dependence - Josh Rosenthal

The Dentist’s Office Must Not Be a Gateway to Opioid Dependence - Josh Rosenthal

A prime entry point for opioid dependence and addiction in teenagers and young adults is the dentist’s office.  Even though there have been significant reductions, opioid-based painkillers are prescribed far too often after routine dental procedures, such as wisdom teeth extraction,  despite the fact that a series of peer-reviewed studies show that non-opioid pain treatment alternatives work as well or better to relieve dental pain. A new Rutgers Health Study published in The Journal of the American Dental Association, for example, finds that a combination of acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) brings more pain relief after wisdom tooth removal than opioids.  

 

According to the R.I. Department of Health Prescription Drug Monitoring Program, Rhode Island dentists wrote more than 17,000 prescriptions for opioid pain killers in 2024; of those, 3,800 were the patient’s first exposure to opioids.. This is a welcome drop in first exposures from 5,003 in 2023.  But we are still overprescribing, and our youth continue to pay the price.

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This significant reduction was due at least partially to the Council to Prevent Opioid Dependence’s active public education campaign targeted to parents of teenagers and to dental professionals.   

 

A Stanford University study published in JAMA Internal Medicine documents the negative impact of these prescriptions. Of nearly 15,000 young people who received initial opioid prescriptions from their dentists in 2015, 6.8 percent had additional opioids prescribed between 90 and 365 days later, and 5.8 percent were diagnosed with opioid abuse during the 12 months after the initial prescription. In a comparison group that did not receive an opioid prescription from their dentists, 0.1 percent got another opioid prescription, and 0.4 percent were diagnosed with opioid abuse over the same period.”

It takes as little as 5 days to become dependent on an opioid painkiller. The pervasiveness of fentanyl and the recent introduction of nitazenes (even more potent synthetic opioids) — make addiction more deadly. There were 329 overdose deaths in our state in 2024 and 55,000 nationally.

 

As the National Opioid Commission states, “We have an enormous problem that is often not beginning on street corners; it is starting in doctor’s offices and hospitals in every state in our nation.” Non-opioid pain treatment for all sources of pain, including dental pain, takes on the problem at the source, severing a gateway to dependence, addiction, and overdoses.  This is all the more important because the path to recovery, even for people receiving high-quality, evidence-based treatment, is challenging, often involves relapses, and is hit or miss in ultimate outcomes.  While it is essential to make quality treatment available to all Rhode Islanders with opioid use disorder, preventing people from starting down the road to addiction in the first place is far preferable.

 

As a parent who has lost his son to a fentanyl overdose in an attempt to manage significant physical pain, we as parents can take an active role in the fight for better education and non-lethal pain management. If your teenager is going in to get his wisdom teeth out, for instance, talk to the dentist or oral surgeon about a regimen of non-opioid pain treatment.  There are state policies that we have put in place that should help with this conversation: medical practitioners, including dentists, are required at first prescription of an opioid pain reliever to warn of risks of addiction and discuss alternative treatments.  This still comes down, however, to individual decisions by medical practitioners and parents and patients.  An active, informed and assertive parent or patient is bound to get a better result.

 

We are continuing our active public education efforts into next year. Together, we can build on the progress we are making, preventing ruined lives and avoidable deaths.

 

Josh Rosenthal, Ed.D., is chairman of the Council to Prevent Opioid Dependence, an organization dedicated to preventing opioid dependence and addiction in Rhode Island and the surrounding region.