I’ve been in health care for over 20 years, but until several years ago I had no idea what opioids were, what they were doing to our society, and the complexity of the problem. I never really paid much attention to when and how many opioid prescriptions I was personally receiving. Rarely have I needed them or taken them, yet over the years I’ve filled various prescriptions and kept them around because it felt like a good precautionary measure (what if the pain got real?), and wasteful to throw them away. I finally got rid of them completely when I learned how much medicine cabinet thievery is contributing to the problem, and with a teenager in the house I didn’t want the temptation lying around.
With heightened awareness of the need to reduce the number of pills prescribed and circulating, I started paying a lot more attention to my own prescription experience. The last two encounters I had demonstrate both the problem and also a solution.
The two events started a few years ago with an annoying tooth. I can’t say it was painful because it wasn’t. I had a few seconds of intermittent sensitivity to cold every few days, but it was more of a nuisance than anything. I brought it up to my dentist at one of my regularly scheduled cleanings and he concluded that the tooth was in the very early stages of dying, but it would likely be several years before I needed a root canal since it wasn’t really bothering me.
Then he gave me a 10-day supply of opioids for the pain.
“What pain?” I was thinking to myself. I had already told him I only had 10 seconds of mild pain at the most once a day, and he said it shouldn’t get any worse for years.
Knowing full well the detrimental power of the script I had I my hand, I walked away dumbfounded that he gave me no education whatsoever about when or even if I should use this addictive medication. Nor did he discuss the more practical option of using over-the-counter alternatives first, and to only fill the prescription as a last resort. When I got home, I promptly tore up the prescription and threw it in the trash.
Having recently contributed to the release of CIVHC’s Opioid Prescribing Patterns Analysis, I reflected on this first experience and realized 1) that I never should have been written that prescription in the first place, and 2) a 10-day supply was a longer duration than I should have received for such mild, acute pain. My chances of addiction if I had filled and taken the full 10-day dose were double that of a five-day dose.
Fast forward two years and even though the pain in that tooth wasn’t increasing, a different dentist recommended taking care of it now before it became a bigger problem. The Endodontist who performed my root canal told me afterwards that I should expect some pain and sensitivity for several days as I recovered.
But this time, I wasn’t given or even offered a prescription for opioids. I was advised to use Tylenol or Advil and to call if the pain became unbearable or worsened.
“What?!” I thought to myself. I just had a root canal and I wasn’t given any pain medication “just in case?”
I have to admit, in this instance I felt a little nervous walking out the door without an opioid prescription in hand. I’ve never had an opioid abuse problem, thankfully, but clearly it was a habit and provided a level of psychological comfort to have that slip of paper just in case!
It turns out the Endodontist was brilliant for not even offering me a prescription. I didn’t have any pain whatsoever after the root canal and I never even needed a Tylenol. By not filling the prescription as a precautionary measure, I saved myself a co-pay and my insurance company money. I reduced the chance that it would end up in the hands of someone I loved, and saved myself the time and hassle of properly disposing of it.
I regret not having a conversation with the first dentist to discuss whether I really needed a prescription in the first place. In his defense, I’m sure he sees plenty of patients who demand a prescription even when they aren’t really having a lot of pain. Instead, patients and providers can and should be discussing alternative ways to manage pain and free our society of the misconception that medications are the only solution. When we stop demanding and receiving opioids when we truly don’t need them, fewer pills will be available, reducing the opportunity for misuse and serious harm.