Getting your wisdom teeth removed should be an easy albeit discomforting fix. But when opioids are prescribed as painkillers, as they often are, this rite of passage can have harrowing life-long consequences.
A new study has found that the road to opioid addiction is much smoother for those teenagers and young adults, ages 13 to 30, who filled out an opioid prescription immediately before or after wisdom teeth surgery.
In fact, this group was found to be 2.7 times more likely than their peers who underwent wisdom tooth surgery but weren’t prescribed opioids to still be filling prescriptions for months after that initial surgery.
“Wisdom tooth extraction is performed 3.5 million times a year in the United States, and many dentists routinely prescribe opioids in case patients need it for post-procedure pain,” says lead author Calista Harbaugh, a researcher and surgical resident at the University of Michigan.
“Until now, we haven’t had data on the long-term risks of opioid use after wisdom tooth extraction.”
Using data on employer-based insurance plans between 2009 and 2015, the researchers focused on the records of young people who tend to be opioid naïve – meaning, they haven’t had an opioid prescription in the six months before surgery and they haven’t had any anaesthesia in the year following surgery.
The findings reveal that 1.3 percent of the 56,686 patients who filled their opioid prescription went on to persistent opioid use, which is defined as two or more prescriptions filled in the next year by any provider for any reason.
For comparison, only 0.5 percent of the 14,256 patients who didn’t fill a prescription went on to develop persistent opioid use.
While this doesn’t seem like much, the sheer number of wisdom teeth removals that happen every year mean a significant number of young people are in danger of using opioids too much.
Those that were most vulnerable to persistent opioid use were found to be in their late teens and twenties. But there were a couple other factors that also predicted the risk of long-term opioid use.
For instance, teens and young adults with a history of mental illness, like depression or anxiety, were found to be more susceptible, as were those with chronic pain conditions.
“We now see that a sizeable number go on to fill opioid prescriptions long after we would expect they would need for recovery, and the main predictor of persistent use is whether or not they fill that initial prescription,” says Harbaugh.
To be clear, the data collected only shows how many opioid prescriptions were filled, and not the actual number of opioids taken. Even still, leftover opioids are arguably more dangerous because they can be misused not only by the patient but also by a member of their household or a visitor.
The authors of the paper suggest that dentists and oral surgeons steer clear of prescribing opioids, and instead fall back on other painkiller alternatives, which may even work better.
But this habit may take some time to break. In 2012, dentists were the second-leading opioid prescribers for children and adolescents.
In an attempt to curb the overprescription of these highly addictive painkillers, The American Dental Association recently mandated an opioid prescribing limit of 7 days or less. Even that may be too much.
“There are no prescribing recommendations specifically for wisdom tooth extraction,” says Harbaugh.
“With evidence that non-steroidal anti-inflammatories may [be] just as, if not more, effective, a seven-day opioid recommendation may still be too much.”
In the US, the opioid epidemic has spiralled out of control, and the younger generation is suffering more than most.
An in-depth analysis of opioid addiction published this year by the Centres for Disease Control (CDC) found that more than 66 percent of those who died from drug overdose in 2016 died from opioid abuse.
What’s more, The National Institute of Drug Abuse reports that young adults, ages 18 to 25, are the biggest abusers of prescription opioid pain relievers.
“Teens and young adults are an important population to understand the effects of exposure to opioids for predictable reasons, like having wisdom teeth pulled. They are vulnerable from the standpoint of ongoing development as well as social pressures,” Harbaugh told ABC News.
The study has been published in JAMA.