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The Role Of Dentistry In The Opioid Epidemic

Ancient Greece was magnificent, relatively sophisticated, and age of advancement in art, poetry, philosophy, politics, and technology.

But, in its history, from 429 to 426 BC, Greece lost an estimated count of 75,000 to 100,000 people, not from war, but in an epidemic known as the Plague of Athens. And ancient Greece was not alone.

Epidemics continue to threaten humanity, losing millions of lives and fracturing civilizations. One of the most devastating pandemics that took 30 to 60 percent of the population of Europe and killed 75 to 200 million people in Eurasia is the Black Death.

Known as the bubonic plague, the disease was caused by the Yersinia pestis and believed to have originated in Central Asia and spread throughout the Mediterranean and Europe from 1346 to 1353. The Black Death re-formed the landscape of Europe. It created upheavals in religion, social, and economic facets of Europe that went on to impact its history.

But, diseases, viruses, and bacteria are not the sole causes of an epidemic. In present-day North America, an “epidemic” is threatening its people — the opioid epidemic.

The year 2016 recorded 11.5 million misusers of prescription opioid with 42,249 people dead from an opioid overdose (that is about 116 people every day), and 2.1 million individuals had an opioid disorder. In less than two decades, from the 1990s, the figures have quadrupled.

Last year, US President Donald Trump declared a national public health emergency on opioid addiction.

What is Opioid?

An opioid is a drug drawn from opium or poppy tears which is a dried latex from the opium poppy. Since pre-historic times, opium has been collected for food, medicine, ritual, and recreational use. It also led to two wars between Britain and China in 1839 to 1842 and 1856 to 1860 in what is dubbed the Opium Wars.

An opioid is not supposed to be bad. It was meant to help patients deal with pain. In fact, the body creates natural opioids which are released when you hurt yourself.

But, the substance which acts on receptors (widely distributed in the brain and found in the spinal cord and digestive tract), can stop the body’s production of its opioids with habitual use.

If you habitually use painkillers, your body will begin to rely on drugs to produce dopamine, boosting the organic chemical and giving people a “high.”

Some examples of the drug include fentanyl, morphine, methadone, hydrocodone, heroin, and oxycodone.

So, why are they addictive?

When you administer the opioid to the body, it enters the bloodstream. Then, it circulates to the central nervous system where they will cross the blood-brain barrier. When the opioid successfully crosses the barrier, it will get into the nervous system and act as an opiate receptor by binding itself to a particular opiate receptor on the brain, spinal cord, or the peripheral nervous system.

One of the opioid receptors the opiate can attach itself to is the mu opioid receptor. When this receptor is overactivated, the gabaergic neuron which inhibits the dopamine neuron is switched off, preventing the holding back up of dopamine neurons.

When you take opioids, you are activating an exogenous system, creating dependency on outside sources of opioids. Habitually using opioid can make your body build up a tolerance, meaning the more you utilize, the higher dose you need to get the same effect, which can lead to overdose.

Opioid Overdose: What You Need to Know

Dopamine is not bad. Dopamine is naturally chemical that motivates the brain and helps in sleep, mood, learning, memory, sex, and movement. Even in high quantity, dopamine is not deadly.

So why is opioid overdose lethal? Endogenous opioid helps in the process called unconscious breathing. Opioid receptors are also found in the region of the brain called pre-Botzinger complex in the medulla.

When the receptors in that area get activated, they tell our breathing to slow down, causing respiratory depression. Respiratory depression is the lowering of the respiratory rate. When an individual takes higher doses of the drug, the breathing rate slows down so much that it finally just stops.

The Role of Dentists in the Epidemic

Dentistry involves treatments and surgeries that may require the prescription of opioids. As prescribers, dentists have a vital role to play in preventing the rise of opioid abuse in the country by educating patients, carefully assessing them for a proper prescription, and recommending treatment for substance abuse if necessary.

In 2009, dentists issued eight percent of total opioid prescriptions in the United States at 6.4 million. However, for people aged 10 to 19 dentists were the primary prescribers of the drug at 30.8 percent or 0.7 million. That age bracket, according to Dr. Harold Tu, is the period when people are particularly susceptible to addiction as the brain is yet to mature.

Also, in a report by the National Institute on Drug Abuse, 75 percent of opioid abusers begin their path to addiction through taking a prescription. In fact, 80 heroin users root their addiction to a prescription.

The American Dental Association has also laid out guidelines and policies related to opioid and its prescription.

In a statement, the ADA advised dentists to check the patient’s medical and dental history. The Association also encouraged dental professionals to review the recommendations for safe prescribing. Moreover, it also called for the use prescription monitoring programs for the promotion of the correct usage of controlled substances.

Dentists must also discuss with patients thoroughly. They must also create treatment plans that use the best practices. Additionally, they must consider other medications and multimodal strategies first before relenting to opioid analgesics.

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