Toothaches for opiates

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The toll of prescription painkiller abuse is rising and, according to the CDC, oxycodone and hydrocodone overdose claimed over 14,000 lives in 2008 alone. And to add to the arsenal of creative ploys such as doctor shopping that addicts use to gain access to these drugs, many are now heading to emergency room departments and complaining of toothaches in order to get their prescription fix.

Why toothaches? Well, as Dr. Gail D Onofrio, chairwoman of the emergency medicine department at the Yale School of Medicine, explains, when it comes to dental pain, it s difficult to make an objective assessment. This means that most physicians will have to rely on patient testimony when prescribing narcotics, since most ERs lack the appropriate diagnostic equipment such as dental X-ray machines to ascertain whether the pain is real or feigned.

And these cases are becoming ever more common in the ER. One contributing factor is that Medicaid government-subsidized health insurance for low-income Americans often lacks adequate dental coverage, forcing many patients to delay treatment until they face a medical crisis. And when these patients arrive at the hospital, almost all request a prescription for narcotic pain pills, says Dr. Bruce Lobitz, an attending physician in the emergency department at Upstate Carolina Medical Center in South Carolina.

Perhaps that s why the number of painkiller prescriptions for dental patients in the ER increased by 26 percent, and antibiotic prescriptions rose by 41 percent, between 1997 and 2007, according to a recent study published in the journal Medical Care.

But while many doctors admit that they may be prescribing painkillers to those who don t need them, they feel that it s a small price to pay compared to not providing adequate relief to those who are genuinely suffering. In fact, some doctors feel pressured to err on the side of prescribing painkillers because patient-satisfaction surveys rate the doctors on how well they managed the patients pain. If you re going to criticize me for not giving out narcotics, and you never praise me for correctly identifying a drug seeker, says Dr. Tom Benzoni, an emergency physician at Mercy Medical Center in Iowa, then I m going to give out narcotics.

ACSH's Dr. Gilbert Ross was surprised to learn of such hospital practices. The issue of having one's prescription choices retroactively critiqued is alarming to say the least, he says. The system must change if excessive narcotic prescriptions are going to be reduced." He adds, The assumption that giving out painkillers to too many patients will create addicts is ridiculous. It s so rare that a non-addict given opiates becomes addicted that it is really a non-issue and a distraction, as opposed to enabling established addicts to procure their drug a real and seemingly increasing problem.