opioid

Oral and Maxillofacial Surgeons Current Perspectives on Opioid Prescribing

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Recently, both insurance companies and politicians in the U.S. have intensified their efforts to limit patients undergoing wisdom teeth surgery to have access to opioids to manage their pain. See the posts on this site: 1) Insurance Companies Limiting Access to Opioids After Wisdom Teeth Surgery and 2) The Effect of Opioid Prescription Limits For Wisdom Teeth Removal. Such efforts have intensified due to recent research showing that opioid prescriptions taken by young adults following wisdom teeth removal has contributed to the opioid addiction and abuse epidemic in the U.S. However, lost in these conversations is the perspectives from oral and maxillofacial surgeons. According to the 2017 white paper by the American Association of Oral and Maxillofacial Surgeons (AAOMS) titled “Opioid Prescribing: Acute and Postoperative Pain Management,” these surgeons feel: “… the practitioner-patient relationship must be upheld, allowing for practitioner … Read more

The Effect of Opioid Prescription Limits For Wisdom Teeth Removal

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Recently it has been discussed how insurance companies have begun to limit prescriptions for opioids for teenagers due to recent studies suggesting that many young adults may later become addicted to opioids as a result of wisdom teeth removal, see Insurance Companies Limiting Access to Opioids After Wisdom Teeth Surgery. In addition to insurance companies taking action, some politicians in the U.S. have proposed legislation to limit opioid prescriptions for seven days. On March 15 2019, U.S. Senators Kirsten Gillibrand (a Democrat from New York) and Cory Gardner (a Republican from Colorado) announced the John S. McCain Opioid Addiction and Prevention Act which would limit the supply of initial opioid prescriptions for acute pain to seven days. This bill would would create a seven-day prescription limit for opioids so that no more than a seven-day supply may be prescribed to … Read more

Insurance Companies Limiting Access to Opioids After Wisdom Teeth Surgery

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Recently on this website, two articles were published discussing possible opioid abuse stemming from prescriptions given after wisdom teeth surgery, see 1) Persistent Opioid Use After Wisdom Teeth Removal and 2) Opioid Prescriptions From Dental Clinicians for Young Adults and Subsequent Opioid Use and Abuse. The first article discussed a 2018 JAMA article which found that that those who filled an opioid prescription from up to 7 days before until up to 3 days after wisdom teeth removal were 2.69 times as likely than those who did not to continue to fill opioid prescriptions weeks or months later after the wisdom teeth surgery. The second article discussed a 2018 JAMA Internal Medicine article which found that being given opioids by a dentist or oral surgeon for those who had never previously used opioids had higher rates of opioid use at … Read more

Persistent Opioid Use After Wisdom Teeth Removal

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An interesting article titled “Persistent Opioid Use After Wisdom Tooth Extraction” appears in JAMA in August 7, 2018, written by Harbaugh et al. (vol. 320, no. 5 , pp. 504-506). The article sought out to see if opioid painkiller prescriptions that many young adults receive after having wisdom teeth removed could set them on a path to long-term opioid use. The authors explored data from patients 13 to 30 years old who underwent wisdom tooth extraction in the Truven Health MarketScan Commercial and Dental database (from July 1, 2009-December 31, 2015). The MarketScan database contains de-identified data from insurance claims and includes 43 million to 55 million beneficiaries annually from the 50 states in the U.S. Patients were excluded from the data the authors explored if there was a lapse in enrollment, if the patient had an opioid prescription filled within 6 months … Read more

Long-acting Local Anesthetic After Wisdom Teeth Removal

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A new medication called Exparel produced by Pacira Pharmaceuticals provides an alternative to opioids for use as pain relief following wisdom teeth removal. Exparel is a long-acting local anesthetic that is delivered during the surgery that numbs the site of surgery for up to three days. Exparel is not an opioid and is not habit forming and therefore will not lead to any opioid addiction. Many patients are already familar with local pain analgesics such as lidocaine that are given as a dental injection to numb an area for several hours. Exparel is a long lasting analgesics which seems to share some similarities but lasts much longer. Recently the use of opioids after wisdom teeth removal has been more closely scrutinzed, see for example https://blog.teethremoval.com/opioid-prescriptions-from-dental-clinicians-for-young-adults-and-subsequent-opioid-use-and-abuse/ and https://blog.teethremoval.com/persistent-opioid-use-after-wisdom-teeth-removal. Many are concerned that patients having wisdom teeth surgery are exposed to opioids … Read more