I want to thank the Kansas Dental Association for allowing me to address a problem that has become a national epidemic. This problem is abuse of prescription drugs. It has made national headlines due to the recent death of actor Phillip Seymour Hoffman who was found dead with an overdose of Heroin. His Heroin habit, however like most, started with an addiction to pain control agents. As a member of the investigative committee of the Kansas Dental Board, I have encountered multiple cases of what would be considered routine and almost random over-prescribing of controlled narcotics.
The most commonly over-prescribed agents are:
• Codeine (usually combined with Tylenol)
• Fentanyl (Actiq, Duragesic, Fentora)
• Hydrocodone (Lorcet, Lortab, Norco, Vicodin)
• Meperidine (Demerol)
• Morphine (Avinza, Kadian, MS Contin, Ora-Morph SR)
• Oxycodone (Oxycontin, Oxyfast, Percocet, Roxicondone)
I have no problem at all with the prudent use of prescription narcotics in our practices when such agents are warranted. Too often, however, I find it difficult to justify prescriptions of controlled substances for simple and routine procedures. Is a simple restoration or the cementation of a crown a requirement for the use of any of the above agents?
When prescriptions are written, too often little discretion is used in the number of tabs, capsules, or c.c.’s that are dispensed. We should check our computer software to be able to tailor each script to the patient’s requirements, and not simply hit the one computer key that delivers the same quantity for all. I have seen Tylenol with codeine suspension given for routine procedures in children and the amount dispensed is enough for a week or more or Lortab dispensed (#30 tabs) for a routine extraction. Is 30 tabs really necessary? The point is, even though we may trust our patients to take only what is needed for their comfort, rarely are the excess dispensed tablets disposed of properly. Most are stored in the home medicine cabinets where teenagers or other family members can easily access the drugs. In some instances, the unconsumed drugs are actually given to a family member or “friend” by the patient when they complain of some ache or discomfort.
In addition, many refills of controlled substances are approved simply when the patient request them. In some of these instances, the patient has either not been seen or has failed an appointment to address the diagnosed problem or even worse, there is no diagnosis noted in the patient’s office record indicating a justification for the prescription. Pharmacy records, when compared to the patient’s office record commonly indicate some refills being approved in excess or five times without a single re-evaluation by the doctor.
Lastly, when we as dentists, hold a DEA License to write or dispense out of our office controlled substances, be cautious of “friends” or family members’ request for them. It is, indeed, difficult not to just once give-in and write that prescription when a family member “needs a refill and cannot make contact with their prescribing physician”.
Yes, schedule II and III drugs have a useful purpose in a dental practice, but we should not overlook the ability of ibuprofen or naproxen in conjunction with acetaminophen in adequate dosage strength and time interval to efficaciously control most of our patients’ pain control needs. When the controlled substances are warranted, let’s be prudent and not be a contributor to or an enabler of a problem that is now sweeping our nation.