Generation Z is getting a large share of their opioid prescriptions from an unlikely source, and a new set of guidelines is suggesting cutting off the supply.
"For pretty much late teens and early 20s, 24 and under, a large portion of those prescriptions are coming from the dental community. Things like dental extractions are so common.” said Dr. Gary Franklin, research professor in the department of environmental and occupational health sciences at the University of Washington, and one of the authors of the guidelines.
The guidelines were released by several private and public stakeholders in Washington State, including the Dr. Robert Bree Collaborative, Washington State Agency Medical Directors' Group and practicing dentists, and suggest patients 24-years-old and younger should either avoid or be given limited opioids for pain at the dentist.
“Especially for adolescents up to 24 years of age, you should probably not use opioids at all, and if you have to use opioids, you probably don’t need more than a few pills," said Dr. Franklin.
Dentists provide 31 percent of opioids to patients between the ages of 10 and 19 years old, according to data cited in the guidelines, and Franklin pointed to many of these patients having their wisdom teeth removed during that age range.
“There is good evidence that a combination of Tylenol and non-steroidals are as good as if not better than opioids in that situation for pain after an extraction," Dr. Franklin said. "If you must use opioids, or if you think you need to use opioids, please limit the number of pills to no more than eight to 12 pills, no more than a couple of days."
Two-thirds of patients receiving opioids for wisdom teeth extractions are 14 to 24 years old, and most of the pills are left unused, according to data cited in the report.
And high school students with an opioid prescription are 33 percent more likely than those witout one to abuse opioids between 18 and 23 years old.
The guidelines also stress the critical role dentists have in minimizing opioid exposure to teenagers, especially considering how widespread the opioid epidemic has become across the country and that developing brains are at an increased risk for addiction.
Dr. Steven Guttenberg, who has been performing wisdom teeth extractions for over 40 years, agrees with the guidelines that the dental community plays an important role in fighting the opioid crisis, but he disagrees with some of the suggestions for how to do it.
“I would feel terrible for a patient that if I sent them home with say ibuprofen which is a good medication, and they wake up in the middle of the night crying in pain which often will happen if you just use that medication, that I was doing a tremendous disservice to that patient," Dr. Guttenberg said.
And he has his own system for trying to prevent abuse when prescribing opioids to teenagers.
“For patients, especially for the younger groups like the high school age kids, I don’t give them the prescription, I give the prescription to the parents, and I advise the patient that if you’re having pain mom or dad will be giving you the medication, and I tell mom or dad that after the patient is done using them to dispose of them properly. I don’t want them sitting around the house to be used on a Saturday night, or given to their friends," Dr. Guttenberg said.
Dr. Guttenberg said he has seen the wider dental community start to take action in trying to curb the opioid epidemic, and he is personally committed in part because of loss he has experienced because of the crisis.
“My son died of a heroin overdose, and he had been given narcotics, not by me, but he had some other surgeries done by other doctors, not dental surgeries. He had been given large amounts and he had a problem with Vicodin previously and kind of beat that and decided to one day try out heroin, and that was the end. So, I kind of know about this and deal with it on a personal level as well," Dr. Guttenberg said.
And over the years, he has taken action too. For example, he started limiting the number of opioids he prescribes.
But overall, he hopes dentists will be allowed to make their own responsible decisions and not be forced to take action.
“I don’t think there should be any law or mandate from a governmental source telling the doctors what to do I think the doctors need to be smart enough to know what to give, when to give it and how much to give," Dr. Guttenberg said.