Making Sense of the Opioid Epidemic

By Dr. Dale Misiek

Opioid use, abuse and addiction have taken over the news on a daily basis. An estimated 44 people die every day in the United States from overuse of opioids, from teens to senior citizens, in isolated rural towns and large cities alike – this epidemic doesn’t discriminate. But what do we really know about these powerful painkillers?

According to the National Institute on Drug Abuse, opioids “reduce the intensity of pain signals reaching the brain and affect those brain areas controlling emotion, which diminishes the effects of a painful stimulus.” Physicians often prescribe opioids such as hydrocodone, oxycodone, morphine and codeine to help patients deal with postsurgical discomfort or chronic conditions. In fact, more than 70 million patients are prescribed opioids following surgery annually, and research shows that one in 15 will go on to long-term use, which can lead to misuse or dependence.

This epidemic is hitting us right in our backyard. In 2012, a federal report from the Centers for Disease Control and Prevention (CDC) showed that in North Carolina, 97 painkiller prescriptions were written per 100 people – making it the 13th highest state for prescribing opioids in the United States. It has also been reported that more than 1,700 prescribers may have been overprescribing painkillers in North Carolina. This has led roughly 34,000 licensed doctors (including myself, an oral surgeon) to take action against this crisis and work together to combat the opioid epidemic by limiting the medications they prescribe to patients.

A recent study published in the Journal of the American Medical Association (JAMA) found that dentists are among the leading prescribers of opioids, and that these medicines are most commonly prescribed for surgical tooth extractions for patients between the ages of 14 and 24. Unfortunately, what can start as a method for pain relief can end in a serious addiction problem, due to lack of communication between patients and doctors on the effects of taking prescription painkillers. It’s important that health care providers have open, honest dialogues with their patients about their pain control options, including non-opioid alternatives.

In my own practice, I recently started using a long acting non-opioid option called Exparel that is injected during surgery. Unlike the usual numbing agents that last only four to six hours, Exparel provides pain relief for up to two to three days. With this pain management alternative, my patients have needed only to take ibuprofen to manage their postsurgical pain following most wisdom tooth extractions. This strategy has been shown to reduce, or, in some cases, completely eliminate, the use of prescription opioids. Since I have been using this approach, the number of patients who come in for follow-up visits for problems due to pain or nausea and vomiting from opioids has gone way down. I have never seen my patients’ pain more effectively managed and with so few side effects in the 34 years I’ve been practicing.

Non-opioid options are becoming more popular in the health care industry as the opioid epidemic continues to be a hot topic for national and local legislatures, and media. The fight against prescription drug abuse must be waged on many fronts, but for many patients, it starts in their doctor’s office. It’s imperative that we actively educate patients on the pain management options available to them, including non-opioids. By doing so, we empower patients to have control over their own pain management plan, while potentially mitigating the societal burden of opioid use.

Dr. Dale Misiek, an oral surgeon at the Carolinas Center for Oral and Facial Surgery.