美国国家公共电台 NPR Dentists Work To Ease Patients' Pain With Fewer Opioids（在线收听）

LOURDES GARCIA-NAVARRO, HOST:

As we've been hearing, doctors face a tough challenge. They need to help ease their patients' pain while considering the risks of prescribing opioids. Dentists are often on the front lines of this problem, and they're looking at new - and surprisingly simple - ways to manage pain. Here's Elana Gordon from WHYY's The Pulse in Philadelphia.

ELANA GORDON, BYLINE: James Hatzell distinctly remembers that spring day his junior year of high school. He was en route with mom in South Jersey to get his wisdom teeth out.

JAMES HATZELL: We're in our 2001 Honda Odyssey minivan, you know, driving to the dentist. And we get there, and I'm just, like, pumped.

GORDON: Yeah, pumped. This was almost seven years ago. Hatzell was 17, and he knew that right after the dentist cut out his molars, a health professional was going to give him his very own legit bottle of pain pills. On the way home, he could not wait to pop that first one. His mom noticed.

HATZELL: You know, she's, like, sort of, like, looking at me a little bit concerned on how much I'm enjoying this.

GORDON: He turned up a certain Pink Floyd song.

HATZELL: Just, like, totally into it, loving it.

(SOUNDBITE OF SONG, "COMFORTABLY NUMB")

PINK FLOYD: (Singing) Comfortably numb.

HATZELL: And we got home, and my mom took the pills and was like - you can't have these (laughter).

GORDON: So that was it?

HATZELL: Well no, that was not it.

GORDON: He knew exactly where that bottle was hidden - Mom's jewelry drawer. He emptied out the pills and replaced them with Advil.

HATZELL: I definitely was every parent's (laughter) worst nightmare.

GORDON: Hatzell says he can joke about this now, but that prescription would mark the start of a downward spiral, one that would include being arrested for dealing drugs in college.

Each year, some 3.5 million young adults get their wisdom teeth out. Dentists are frequent prescribers of opioids for short-term pain. When Dr. Joel Funari started practicing more than 30 years ago, he says it was common to prescribe 30 or more Vicodins or Percocets after such procedures.

JOEL FUNARI: Dentists don't like to see patients in pain. They want to get them out of pain. You know, we tend to be compassionate people, and I think we were falling into a trap that we were creating ourselves.

GORDON: Funari practices in a suburb of Philadelphia, and he's part of a group that developed Pennsylvania's first-ever dental guidelines for opioid prescribing. He says research actually shows...

FUNARI: That the Motrins, the Advils, the Aleves, when used in a certain way, were very effective, more effective than the narcotics.

GORDON: They keep the swelling down, which Funari says is a main source of the pain. The guidelines now recommend using these medicines first. It's all a big culture shift. Elliot Hersh, a professor of oral surgery at the University of Pennsylvania, says anti-inflammatory drugs like ibuprofen...

ELLIOT HERSH: They don't have as much hype - why? - because they're available over the counter. And what a lot of the lay public believe is that if they're available over the counter, they're weak and they don't work.

GORDON: The National Dental Association and some other states are now following Pennsylvania's lead in drafting new guidelines. If dentists are going to prescribe opioids, they should use caution and check a statewide database to review patient prescription histories. And Hersh says it's important to take a hard-line approach when training future dentists.

HERSH: I've been teaching my students that if you write too many of these drugs, for either good intentions or bad intentions, either the state dental board and/or the DEA is going to come down on you.

GORDON: But this isn't an exact science. Hersh says a small portion of patients will need an opioid. But it's hard to predict who that will be. James Hatzell does not want to be one of them. He is in year three of his recovery. One of the most terrifying thoughts is that one day he might need surgery and then get prescribed pain meds.

HATZELL: I don't want to take any at all. But, you know, I might be put in a situation where it's medically appropriate for me, and I don't want to have to make that decision.

GORDON: Now when Hatzell goes to the dentist, he says right upfront he cannot take narcotics, which means, more and more, dentists are going to have to figure out how to respond to these tricky situations.

For NPR News, I'm Elana Gordon in Philadelphia.

GARCIA-NAVARRO: Her story is part of a partnership with NPR, WHYY's The Pulse and Kaiser Health News.

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(SOUNDBITE OF MOSS OF AURA PIECE, "FOOLS")