Tuesday, May 31, 2016

Can We Maybe Cool It with the RXs?

Lately it seems like the fun never stops around here. Yesterday I turned my family's world upside down (sort of) by accepting a new job that will eventually require us to relocate. Today I went to an oral surgeon for what I thought was going to be a consultation on having an aching wisdom tooth extracted. Except that a few minutes into the appointment, I was informed that they were actually pulling my tooth today.

Who knew?

Needless to say, I was completely unprepared. Thankfully, though, everything went off without a hitch. It's been a couple of hours since my tooth was yanked out, and my mouth is still pretty numb. The same goes for my my cheek, chin, tongue, and wallet (no dental insurance). When you throw in the gauze I'm biting down on, I kind of look and sound like the second coming of Marlon Brando in The Godfather. Except I'm guessing he didn't drool like I have been.

I felt no pain whatsoever during the extraction. I guess the combination of three shots of novocaine and some nitrous oxide did exactly what it was supposed to do. (Whew!) Of course, the doctor told me I wouldn't be getting off totally pain-free, so he was sending me home with a couple of prescriptions for pain relievers. "They don't let us phone these prescriptions in anymore, so we'll give them to you now in case you need them."

When I got home, I took 800mg of Motrin, changed my gauze, and opened up the envelope the doctor had sent home with me.

What I found made me mad.

In addition to a sheet of post-op care instructions, some more gauze, and a prescription for amoxicillin, there were two other prescriptions: one for thirty Norco tablets and one for 20 Percocet tablets. In case you didn't know, Norco contains a combination of acetaminophen and hydrocodone (an opioid); and Percocet contains a combination of acetaminophen and oxycodone (a stronger opioid). The instructions told me to take the Norco first, and if that didn't help relieve the pain then switch to the Percocet.

I was kind of surprised to see that I had been prescribed a total of 50 opioid pain relievers for the extraction of one wisdom tooth. I understand that I might experience some pain in the next day or two (or three or four), but isn't 50 pills a bit much? And why not just prescribe one pain reliever, with the caveat that if it doesn't do the job, call our office and we'll discuss it? It seems to me that pills are being overprescribed in the interest of convenience. Doctors can't phone in prescriptions for narcotics anymore, so they give you prescriptions you may not need...just in case.

That's wack.

I plan on sticking to just Motrin if at all possible. (If you follow this blog, you may recall that my son did that a couple of years ago when he had two wisdom teeth pulled.) I figure there's no sense in going overboard if I don't have to.

I wish doctors shared the same philosophy.

Did you know?

  • Health care providers wrote 259 million prescriptions for painkillers in 2012, enough for every American adult to have a bottle of pills.
  • More people died from drug overdoses in 2014 than in any year on record. The majority of drug overdose deaths (more than six out of ten) involve an opioid.
  • Since 1999, the rate of overdose deaths involving opioids (including prescription opioid pain relievers and heroin) nearly quadrupled. From 2000 to 2014 nearly half a million people died from drug overdoses.
  • Since 1999, the amount of prescription opioids sold in the U.S. nearly quadrupled, yet there has not been an overall change in the amount of pain that Americans report. Deaths from prescription opioids--drugs like oxycodone, hydrocodone, and methadone--have also quadrupled since 1999.
  • 78 Americans die every day from an opioid overdose and overdoses from prescription opioid pain relievers are a driving factor in the 15-year increase in opioid overdose deaths.
  • The United States has less than 5% of the world’s population, but uses 80% of the global supply of opioid drugs.
(Source: Centers for Disease Control and Prevention)


  1. You're right, Dean. The amount of pain medicine you were given for one tooth is ridiculous. It should have been a max of 10 Norco and, as you noted, the Percocet shouldn't even have been in play unless you had a bad reaction to the extraction. Frankly, the advances in pain-free dentistry in recent years have been so impressive that the three root canals I've had in the last decade literally *did not hurt* at any point. I realize not everyone is so lucky, but you bring out the big guns only when lesser treatments fail.

    In addition, this type of prescription makes patients feel that this is the amount of pain medication they should always be given in any medical situation where pain might occur, so they pursue their doctors to provide it. Some doctors know not to give in, others take the path of least resistance and hand them out like candy, making it seem as if these drugs aren't the very powerful, very (potentially) dangerous meds they are. That is a bad thing all the way around and desensitized the public to the amount of danger present when you use opioids.

    The real irony here is that despite the ridiculous amount of overprescribing that happens daily here in the U.S. that you described above, it is still incredibly difficult for many people with chronic, painful diseases to get ANY kind of opioid pain medicine. I know some people won't believe that, but it is very true, especially for those unfortunate enough to have an "invisible" pain disease (e.g., lupus, arthritis, fibro, many other autoimmune diseases). If you don't "look" sick, good luck getting pain meds for more than a month. Too many doctors are quick to believe that patients are a) exaggerating their pain or, b) they're really suffering from depression or a mental illness and the pain is "all in their head." This is especially true for female patients, who face being labeled"crazy" far, far more often than men do (I've seen this first-hand from some of my own doctors). It's a truly maddening dichotomy here in the States: true drug-seekers can always find a pill mill or steal left-over meds from family members--meds that never should have been prescribed in the first place--because too many doctors hand out powerful meds too easily while people truly living in horrible pain every day of their lives are very often fighting an incredibly uphill battle to receive anything stronger than prescription-strength motrin.

    It's a sad and often dangerous conundrum on both sides of the issue. I wish I had answers.

  2. holy shit! That is insane! I have had 8 pulled and you don't need opiates for a pulled tooth. If you decided to take them you would only need one right after the novocaine wore off.This is why so many people are becoming addicted to opiates. Irresponsible prescribing.

  3. That is over the top Dean. I'm curious if the dentist asked you if you had any previous dependency on prescription drugs or any conversation along those lines. My nephew recently went home after a procedure with a prescription of pain medication and I was surprised to learn that the doctor did not ask more questions about his drug history. Your experience is definitely part of the problem.