By Jay Baruch – Published by STAT News

Sonny D is cupping his jaw with both hands, writhing on the gurney, and pleading with me to give him “something for the pain.” His teeth, those that remain, are a ragtag crew of decay. He’s been popping ibuprofen like candy. Antibiotics no longer help. He needs a dentist, but he lacks insurance and the private dentists he contacted won’t see him without cash upfront. “I’m trying, doc,” he says, as if reading what I’m thinking. “You think I want to be here?”

I don’t know what to think. Looking into his mouth makes my own jaw throb. But I do know that 4 of 5 new heroin users kickstarted their habits by abusing painkillers. Opioid painkillers and heroin were responsible for nearly 50,000 lives lost in 2016 from drug overdoses. In my emergency medicine practice, these statistics have faces, and sometimes these faces have rotted teeth.

Sonny (not his real name) wants what he says worked the last few times he came to the emergency department for dental pain. He’s asking for Vicodin, a combination of the opioid hydrocodone and acetaminophen. It’s in the top five most commonly prescribed drugs in the United States. Opioids — whether it’s Vicodin or oxycodone or many others — have transformed dental and other pain into a moral and clinical cage fight. This struggle is lost in the headlines that blame physicians for the opioid crisis. It ignores the on-the-ground experiences of many of us who strive to do the right thing when the “right thing” is the very thing in question.

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