Dentists
should be aware that patients may seek prescriptions for benzodiazepines or
opioids in order to misuse or sell those drugs.
Requests
for benzodiazepines generally involve new patients who claim to be very
apprehensive about dental treatment and who may display anxiety characteristics
during their dental examination. They often inform the dentist that their
previous dentist always prescribed ‘something to calm me down’ and that it was
‘the only way that the dentist could do any work on me’.
Dentists
need to have a level of suspicion when receiving such requests, especially when
patients identify drugs by name, or cannot recall or are unwilling to divulge
the name and locality of their previous dentist. Contact with the patient’s
previous dentist or their medical practitioner can assist in identifying the
bona fide case from those seeking prescriptions for misuse. Also, prescription
of one or two tablets only, rather than a full pack, can be helpful to avoid
misuse.
In
Australia, the National Drug Strategy Household Survey 2013
1
identified misuse of analgesics as showing the largest increase between 2010
and 2013 of all drug types surveyed. It found that 7.7% of people in 2013 had
used them for non-medical purposes compared with 4.8% in 2010. Those seeking to
misuse opioids may do so with over-the-counter medicines which combine codeine
(12.8 mg) with ibuprofen (200 mg), and also codeine (15 mg) with paracetamol
(500 mg). The most commonly misused prescribed opioid in Australia was a
combination of codeine and paracetamol.1 Such
combinations consist of codeine (30 mg) and paracetamol (500 mg). These drugs
are recommended for the management of severe pain after dental treatment at
adult doses of codeine (60 mg) plus paracetamol (1000 mg) given every four
hours (to a maximum paracetamol dose of 4 g every 24 hours).2
Patients
who are seeking opioid prescriptions may claim to have severe dental pain, may
present with self-inflicted intra-oral injuries, or may even deliberately irritate
extraction sockets or ongoing root canal therapy. Dentists need to be
suspicious of patients who wish to have ‘drug-only’ treatment and either refuse
or are not interested in non-drug treatment. The
Box
shows suggested responses to a patient seeking drugs.
Box Suggested responses to a patient seeking drugs from
a dentist
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Opioids
‘The drugs you are seeking are not appropriate for your
particular problem. I think you should discuss this with your medical
practitioner (I could contact them if you like), or if your pain is very
severe, perhaps you should attend hospital.’
Benzodiazepines
‘I do not prescribe the drugs you are seeking. I think you
should discuss this with your medical practitioner (I could contact them if you
like), or I could refer you to a specialist who manages anxious patients.’
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Conflict of interest: none declared
