As the current opioid epidemic continues to grow and impact communities across our nation, one of the challenges I face as a dental provider is assisting my patients in very real pain while also considering the body of evidence linking opioid overprescription with addiction.  To address this correlation, I’d like to briefly discuss the practices I have always followed in prescribing pain relievers.  First, there are many compelling studies that show that taking Ibuprofen and Acetaminophen together at certain dosages are more effective than traditional opioid medications (see https://www.nytimes.com/2018/04/25/well/common-pain-relievers-beat-opioids-for-dental-pain-relief.html).  Studies have examined the way in which these two medications, when taken together, amplify each other and become more effective at controlling pain.  For many adult patients, a dosage of 600mg of Ibuprofen (3x Advil regular strength) and 650mg of Acetaminophen (Tylenol 2x regular strength) taken together every 5-6 hours can help to manage pain until we are able to determine the dental issue they may be experiencing, or during recovery post treatment.

Opioids, although a good pain reliever, have some very nasty side effects. The most obvious effect of opioids is that they are incredibly addictive. National prescription policies have been linked with a substantial increase in opioid related deaths and higher levels of addiction nationwide.  Long-term dependence on opioids, besides its damaging effects on the addicted individual’s quality of life as it relates to mental, social and financial considerations, can cause major health concerns, including nausea and vomiting, constipation, liver damage, brain damage due to hypoxia (depressed breathing) and in many cases, death. Opioids impair mental and physical activity and should be avoided in patients needing to drive or operate heavy machinery.

We understand that dental emergencies happen and pain is, unfortunately, a significant side effect of any oral condition.  It has long been the policy of Cascadia Dentistry to only prescribe any opioid-containing medications as a last resort and only at minimal quantities.  Our first line of pain management will continue to be the combination of Ibuprofen and Acetaminophen to help our patients manage their discomfort until we can assist with addressing the source of their pain through treatment at our office.

If you have any questions about this policy or how Cascadia is focused on reducing the risk of addiction in our communities, please do not hesitate to contact us to discuss further. For more information about our nation’s opioid epidemic, please see https://www.cdc.gov/drugoverdose/prescribing/guideline.html