ER Doctors Pressured to Provide Opiates for Toothaches

The New York Times

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recently reported on an emergency room doctor in South Carolina who is wary of patients who complain of toothaches. Dr. Bruce Lobitz fears that the majority of these patients are using tooth pain as an excuse to get prescriptions for opiate painkillers like OxyContin, OxyNEO, or Vicodin. His fears are well founded – almost all the dental patients he sees request a painkiller prescription to “tide them over” until they can get to a dentist. Some of the even go so far as to claim they are allergic to all drugs except Vicodin. In these cases it is hard to deny a vicodin addiction is at the root of the issue.

It’s common for people who are without medical insurance to visit the ER when facing a health crisis. In many states, adult dental benefits available under Medicaid have been cut back or eliminated altogether. For these patients, the ER may be the only recourse for tooth pain. Unfortunately, ER doctors have no way of telling for sure if a patient who’s complaining of toothache is really in pain. Most ER doctors are not trained to provide emergency dental care and very few emergency rooms are equipped with dental x-ray machines, making it nearly impossible to diagnose most dental problems.
The National Institutes of Health recently financed the first study that looked at the connection between emergency room visits for dental problems and painkiller prescription. The study, which looked at hospital data from the years 1997 through 2007, found that 75% of ER visits for a dental complaint led to a painkiller prescription being written. During the same period, the number of ER painkiller prescriptions written for dental problems rose by 26%.
Many ER doctors experience the pressure of heavy case loads and are attempting to stabilize patients by prescribing painkillers, unaware that a local anesthetic injection can provide up to 16 hours of relief from dental pain. According to the New York Times, some doctors may be prescribing painkillers to patients who don’t need them because they are worried about patient-satisfaction surveys that will criticize them for not providing pain relief.
ER doctors have one useful tool that can be used to screen for patients who are abusing prescription drugs. Forty states now have online prescription drug monitoring systems that allow doctors to check a patient’s prescription history. The system can alert a physician to patients who are doctor shopping for drugs. Unfortunately, few doctors are making use of this tool. According to John Eadie, director of the Prescription Monitoring Program Center of Excellence at Brandeis University, “Unfortunately many emergency physicians don’t realize the importance of a quick check of the database to see how many painkiller prescriptions a patient has filled lately.”

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