Opioids in Dentistry 

Dental offices are often where patients first receive opioid medications. But what seems like normal pain control can become the starting point for long-term opioid use. This problem places dental professionals in an important role for prevention and patient education too.

One thing that really stood out in my research is how risky early exposure is because of how opioids interact with the brain. These substances affect the brain's reward system and can rapidly cause tolerance and physiological dependence (U.S. Department of Health and Human Services [HHS], 2016). In particular, the danger level is high for teenagers and young adults since their brains are still maturing (Levy et al., 2018). Research also mentions that patients receiving prescription opioids after dental visits have a 2.7 times higher chance of drug use continuation even after several months (Harbaugh et al., 2017). In the past, dentists have been one of the primary contributors to opioid prescriptions in the United States. In 2016, US dentists prescribed opioids over 11.4 million times, which was almost 37 times the rate of those in England (Reynolds & Schwarz, 2019). Of course, the huge volume of this has had its effect on us, too, as overdose deaths nationally exceeded 80,000 in 2021 (CDC, 2025). Dental opioid prescribing patterns have been dramatically improved in the U.S. with almost a 45% reduction achieved from 2016 till 2022, yet the sad truth is that over 7.4 million patients were still given such prescriptions in the year 2022 (Gavin, 2023). The main reason behind this still being a problem is the few doctors who insist on prescribing these drugs in large amounts (Gavin, 2023).

Since opioids are dangerous, the researchers have been seeking alternative ways to assist patients efficiently and safely. An extensive research including 58,000 patients revealed that the combination of ibuprofen and acetaminophen not only was safer but works better than opioids (Moore et al., 2018). Reynolds and Schwarz (2019) also supported that non-steroidal anti-inflammatory drugs (NSAIDs), which refer to ibuprofen and the like, can perform equally well or even better than opioids for the majority of dental treatments. The answer lies in biology that opioids mainly deceive the brain and alter its perception of pain, while the treatment that actually causes pain is not being addressed. On the other hand, NSAIDs work by eliminating swelling and inflammation from the hurt area (Ghlichloo & Gerriets, 2023). At present, the American Dental Association is in favor of NSAIDs as the first choice, thus leading to a new standard where patient safety is the priority. 

Apart from the use of non opioid medicines, pain relief is also dependent on some practical ways. Locally administered anesthesia and nerve blocks of long duration can make patients feel good for a few hours after the procedure (CDC, 2024). Another method is cold compresses during the first 24 to 48 hours (CDC, 2024). They are effective in minimizing swelling and the pain of the area. Proper post operative instructions, such as rest and good hygiene also help avoid problems that may lead to more pain. 

CO State Prevention Efforts 

I think it’s great that Colorado is backing these clinical changes with strong laws. For instance, the law in Colorado limits initial opioid prescriptions for acute pain to a 7-day supply only (Colorado Revised Statutes 12, 30, 109). In addition, Colorado mandates that controlled substances be prescribed via electronic prescription to combat prescription forgery and enhance prescribing accuracy (Colorado Revised Statutes 12, 30, 108). To prevent opioid misuse, prescribers are required to check the Prescription Drug Monitoring Program before giving any further opioid prescription (Colorado Revised Statutes 12, 30, 109). Naloxone is available statewide through a Standing Order that allows anyone to obtain it without a personal prescription (Colorado Revised Statutes § 12-30-110).

Additionally, Colorado’s emphasis on accessible emergency care is reflected in its approach to dental practice. The state has expanded the scope of practice for dental hygienists, allowing us to independently administer life-saving medications. This is not just about whether we are allowed or trained to give the medication. It is about the fact that some patients hide their addiction, so we might treat someone who is at risk and not know it. So we have a duty to be prepared, as the risk could be there even if the patient doesn't tell us. Personally, having naloxone on hand is a way we can be proactive in case of any emergency. I think it's mainly about healthcare practitioners becoming truly answerable to the safety of their patients and being aware that their interventions can make a significant difference at that very moment.

The report from the Surgeon General fundamentally re-oriented addiction to one of the major healthcare professionals as a misconception about a "character defect," but rather as "a chronic disease that we should deal with in the same way, using the same skill and compassion, as diseases like heart disease, diabetes, and cancer" (HHS, 2016, p. v). This distinction is a significant advancement in the dental profession because if patients feel that the environment is free from judgment, they will be more comfortable revealing their problems, which will allow us to provide safer treatments. This report additionally highlights the importance of acknowledgment, teaching, and insists that all healthcare providers should be actively involved in prevention and intervention (HHS, 2016). Just simple procedures in the dental setting, such as going over a patient’s medical history or treatment plan discussion, may also serve as good moments for educating and supporting the patient. The report also revealed that dentists and their staff are not only the solution providers for dental health issues but also the ones who help patients to know and be supported by their overall health and well-being.

Looking at the opioid epidemic from the perspective of dental care is eye opening to me in terms of how much our profession really matters. When we manage pain, check medical histories and talk to patients; any of these actions can help prevent problems that we are not even aware of.

References:

CDC. (2025, May 21). U.S. Overdose Deaths In 2021 Increased Half as Much as in 2020 – But Are Still Up 15%. NCHS Pressroom. https://www.cdc.gov/nchs/pressroom/releases/20220511.html

CDC. (2024). Nonopioid therapies for pain management. Overdose Prevention. https://www.cdc.gov/overdose-prevention/hcp/clinical-care/nonopioid-therapies-for-pain-management.html‌

Gavin, K. (2023, November 2). Dental opioid prescriptions still declining, but not as quickly as pre-pandemic.

Michigan Medicine Health Lab. Retrieved February 12, 2026, from https://www.michiganmedicine.org/health-lab/dental-opioid-prescriptions-still-declining-not-quickly-pre-pandemic

Colorado Revised Statutes § 12‑30‑109. (2024). Division of professions and occupations, article 30, part 1: Prescriptions for controlled substances. Retrieved February 12, 2026, from https://law.justia.com/codes/colorado/title-12/division-of-professions-and-occupations/article-30/part-1/section-12-30-109/

Colorado Revised Statutes § 12‑30‑108. (2024). Division of professions and occupations, article 30, part 1: Prescription drug monitoring program. Retrieved February 12, 2026, from https://law.justia.com/codes/colorado/title-12/division-of-professions-and-occupations/article-30/part-1/section-12-30-108/

Colorado Revised Statutes § 12‑30‑110. (2024). Division of professions and occupations, article 30, part 1: Standing order for naloxone. Retrieved February 12, 2026, from https://law.justia.com/codes/colorado/title-12/division-of-professions-and-occupations/article-30/part-1/section-12-30-110/

Harbaugh, C. M., Lee, J. S., Hu, H. M., McCabe, S. E., Voepel-Lewis, T., Englesbe, M. J., Brummett, C. M., & Waljee, J. F. (2017). Persistent Opioid Use Among Pediatric Patients After Surgery. Pediatrics, 141(1), e20172439. https://doi.org/10.1542/peds.2017-2439

Ghlichloo, I., & Gerriets, V. (2023). Nonsteroidal anti-inflammatory drugs (NSAIDs). PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK547742/

Levy, S., Breen, L., Lunstead, J., & Weitzman, E. R. (2018). Facing Addiction: A Laudable, but Incomplete Effort. American Journal of Public Health, 108(2), 153–155. https://doi.org/10.2105/ajph.2017.304230

Moore, P. A., Ziegler, K. M., Lipman, R. D., Aminoshariae, A., Carrasco-Labra, A., & Mariotti, A. (2018). Benefits and harms associated with analgesic medications used in the management of acute dental pain: An overview of systematic reviews. The Journal of the American Dental Association, 149(4), 256-265.e3. https://doi.org/10.1016/j.adaj.2018.02.012

‌Reynolds, W. R., & Schwarz, E. S. (2019). Dentists’ Current and Optimal Opioid Prescribing Practices: A Proactive Review. Missouri Medicine, 116(5), 347. https://pmc.ncbi.nlm.nih.gov/articles/PMC6797033/

U.S. Department of Health and Human Services (HHS), Office of the Surgeon General. (2016). Facing addiction in America: The Surgeon General’s report on alcohol, drugs, and health. https://www.hhs.gov/sites/default/files/facing-addiction-in-america-surgeon-generals-report.pdf