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Firsts can be life-changing - think about your first kiss, your first time behind the wheel of a car. But what about the first time you got a prescription for a narcotic?
"We're in our 2001 Honda Odyssey minivan, driving to the dentist," Hatzell recalled. "And we get there, and I'm just pumped. I was very excited to get my wisdom teeth out."
The prospect of pain didn't thrill the teen, but he'd heard from friends that when the dentist took out his teeth, he'd get his very own bottle of pain pills.
Those pain pills, Hatzell now says, eventually derailed his life.
Dentists have long been frequent prescribers of immediate-release opioids like Vicodin and Percocet for the pain from tooth extractions. That's a lot of pills and teeth; annually more than 3.5 million people, mainly young adults, have their wisdom teeth removed.
For many patients, these drugs never pose a problem. But deaths of some 165,000 people in the
So dentistry is at a crossroads. Many in the field are now reassessing their prescribing habits, with state dental boards and associations issuing new guidelines for patients and practitioners. As of this year,
Hatzell says he was always a little afraid of narcotics in high school, until that day he had dental surgery. He'd tried Vicodin recreationally before that, he says, but with caution. Friends would find an extra pill in a medicine cabinet at home; they'd crush it, mix it with pot and share it.
But getting his own prescription from a health professional felt different, Hatzell recalled. It seemed legitimate - like maybe it wasn't as dangerous as he'd feared.
On the way home from the dentist's office that day, Hatzell was still high from the drugs he was given during the procedure and could not wait to pop his first pill.
His mom noticed.
"We got home, and my mom took the pills and was like, 'You can't have these,'" he said.
But he knew where she'd hid the bottle. When she wasn't watching, he sneaked into her room, emptied out the pills and replaced them with Advil.
"I definitely was every parent's worst nightmare," Hatzell said, laughing.
He can joke about that day now, he said, but what opioids did to him and his family wasn't funny. A few years later, he was arrested for dealing drugs in college.
A 2011 study in the
"Dentists don't like to see patients in pain," Funari explained. "We tend to be compassionate people, and I think we were falling into a trap we were creating ourselves."
In 2014, Funari joined a group tasked by the
"Non-steroidal anti-inflammatory drugs - the Motrins, the Advils, the Aleves - when used in a certain way, are very effective," Funari said. "More effective than the narcotics."
NSAIDs reduce inflammation, which is a main source of the pain, he said. And because wisdom tooth removal is so common, it has actually been an ideal procedure to study the benefits from this alternative in treating pain.
The 2014 guidelines that Funari and his colleagues came up with are the state's first to tackle how to best use a combination of opioids and other drugs to manage pain in dental patients. National discussions have been expanding, too.
The effort to get dentists and dental students to be wiser prescribers recently became personal for Moore. Among the more than 3,000 overdose deaths in
"I'm very sensitive to the issue," he said.
Prescribing more pills than are needed to mitigate pain, Moore said, leaves extra pills or an unused prescription that can be sold or abused.
"I've been teaching my students that you have to be really, really careful with these drugs," he said. "That if you write too many of these prescriptions, for either good or bad intentions, either the state dental board and/or the
Hersh said one of the biggest hurdles in improving prescribing habits is countering - among his students, practicing dentists and patients - long-held misunderstandings about the pain-relieving power of less addictive drugs.
NSAIDs work at least as well as opioids, he said; they just haven't received as much hype, because they're available over the counter.
"A lot of the lay public believes if they're available over the counter, they're weak and they don't work," Hersh said.
Hatzell is 23 and has been in recovery for his opioid addiction for three years. He says one of the most terrifying thoughts he faces as he navigates his recovery is that he might need surgery one day and again need pain medication.
These days, whenever he goes to a dentist or doctor, he makes it a point to say right up front that he cannot take opioids.
(c)2017 Kaiser Health News
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