Wisdom Teeth Removal + Teens + Opioids = :(
When my son was in treatment the second time around, he was living out of state and I got a call that he needed all 4 of his wisdom teeth removed. This presented a difficult decision for us because clearly it wouldn't have been a good idea to give him opioid pain killers post-surgery, but there wasn't a great alternative at the time given the severity of how impacted his teeth were. In the end, we worked with his oral surgeon to determine what medication would be ok - agreeing on prescription strength Tylenol only. It wasn't the most pain-free or pleasant experience for my son but he also wasn't exposed to any more opioids or at risk for relapse.
This is fairly routine - sometime before the age of 20-ish many teens are told they need to have their wisdom teeth removed, which seems like a (painful) but relatively harmless procedure. But here's something many parents and teens don't think about - dentists and oral surgeons are the number one prescribers of opioids for adolescents aged 10-19. Psychiatrist Andrew Kolodny, co-director of opioid policy research at Brandeis University’s Heller School for Social Policy and Management and executive director of Physicians for Responsible Opioid Prescribing, warns that teens who are exposed to opioids during this process are much more likely to use them non-medically (recreationally) later in life.
A 2015 University of Michigan survey showed young people exposed to opioids by the end of high school had an overall 33 percent increased risk of opioid misuse between the ages 19-25. “Good kids”—those teens categorized as at low risk of future drug abuse—were at 300 percent greater risk. These are kids who actually reported disapproval of regular marijuana use, according to the National Institute on Drug Abuse. Why this high risk? The brain isn't fully developed until age 25, and before that age people are at higher risk for 3 reasons:
Young people are going to get more of a dopamine “kick” than an adult would from the same amount of opioids because of lower baseline dopamine levels in their developing brain.
Until the brain is fully developed, it doesn’t assess risk very well, accounting for the tendency of younger people to take more risks, including risky drug behavior.
Brain plasticity. MRI scans show structural studies changes from as little as 30 days of daily opioid use, with no evidence of reversal after six months. If a patient is sent home with 30, 60 or even more opioid pills after a wisdom tooth removal surgery, this exposure is highly risky.
Parents need to be aware of this risk, as kids are basically being given heroin in pill form - and even though it's coming from a trusted medical professional, it's up to the parent to protect their child and ask for an alternative. Slowly, oral surgeons are replacing opioids with safer alternatives for their patients, one of those being Exparel, a relatively expensive, yet long-acting anesthetic that was approved in 2016 for oral surgery use. It's non-addictive and numbs the area for 2-3 days which can reduce or eliminate the need for additional pain medication beyond ibuprofen and acetaminophen.
Aetna currently covers the cost of Exparel - if your child is going to be getting their wisdom teeth removed you should consider contacting the doctor in advance to find out what pain management alternatives they offer.