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Opioids (used to treat pain): Prescription opioids act on the same receptors as heroin and can be highly addictive. People who abuse them sometimes alter the route of administration (e.g., snorting or injecting) to intensify the effects. Some even report moving from prescription opioids to heroin. It is estimated that approximately 1.7 million people in the U.S. meet the abuse or dependence criteria for prescription opioids. Abuse of opioids, either alone or with alcohol or other drugs, can depress respiration or lead to death. In 2018, an average of 41 people died each day from overdoses involving prescription opioids, totaling nearly 15,000 deaths. Prescription opioids were involved in 32% of all opioid overdose deaths (Figure 11).7 Between 2017 and 2018, due to several public health interventions, there was a 13.5% decrease in prescription opioid-involved death rates.8,31
While hydrocodone and oxycodone may be familiar prescription opioid analgesics that are also commonly abused, there are two more about which the dental healthcare provider should be aware: fentanyl, a synthetic opiate and carfentanil, a derivative of fentanyl. Fentanyl is a powerful analgesic like morphine but up to 100 times more powerful and carfentanil is 100 times stronger than fentanyl. The legitimate use of fentanyl is generally limited to end-of-life pain management.
Due to the highly addictive nature of the opioid pain relievers, the dental practitioner should consider alternative non-opioid standard approved by the Federal Drug Administration.50 This involves the mnemonic 2-4-24, taking two drugs in four doses for 24 hours. The two drugs are ibuprofen (600 mg) and acetaminophen (650-1,000 mg), which are taken together every 6 hours (four doses) for the first 24 hours.16
CNS Depressants (used to treat anxiety and sleep problems): These drugs are addictive and, in chronic users or abusers, discontinuing them abruptly without a physician's supervision can cause severe withdrawal symptoms, including seizures, which can be life-threatening.
Stimulants (used to treat ADHD and narcolepsy): Misuse of stimulants can cause addiction and other health consequences. These include psychosis, seizures, and cardiovascular complications.32
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