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The Deadly Triangle: Dentists, Drugs and Dependence

Like about five million people each year, 27-year-old Brittany Ringersen had her wisdom teeth removed when she was a teenager.
Brittany Ringersen
3-year-old Brittany Ringersen (left) and cousin Samantha (right) playing.

Like about five million people each year, 27-year-old Brittany Ringersen had her wisdom teeth removed when she was a teenager. But what Brittany’s dentist failed to warn her was that her prescription for Percocet, a commonly used painkiller for post-surgery discomfort, had the potential to lead her down a path of dependence.

“There was no dialogue with me or my family about the potential harm that it could cause or the potential to be abused,” says Ringersen. “There was not any conversation that I could remember that was ever had in regards on to how to or not to take the pills.”

Ringersen was prescribed a 30-day supply of the opioid, a class of drugs that chemically follows the same neural pathways as heroin, eliciting a sense of euphoria. Despite having pain for only a few days, Ringersen continued taking the Percocet simply because it felt good and extra pills were left in the bottle. And with each pill she felt more and more powerful.

“I had this great thing sitting in my drawer and thought what I was doing not using it,” says Ringersen. “I knew I shouldn’t have been doing it. It felt wrong to do, but my name was on the bottle and my parents never questioned it.”

Brittany Ringersen and friend
17-year-old Brittany Ringersen (left) with friend Amber (right) at a party.

In less than a month, Ringersen went from an average 16-year-old high school student to a desperate drug addict. Surprising as this may seem, her story is an all too common one. Recently, a Harvard research team reported in the Journal of the American Medical Association (JAMA) that dentists are among the leading prescribers of opioid analgesics, particularly for surgical tooth extractions. The most revealing aspect of the study was that the highest number of these opioid painkiller prescriptions were for teenagers, aged 14 to 17 years old, closely followed by young adults 18 to 24 years.

“There are sky rocketing rates of opioid abuse,” says study author Dr. Brian Bateman with the Division of Pharmacoepidemiology and Pharmacoenocomics at Brigham and Women’s Hospital. “We see it across medical and dental practices that physicians and dentist are giving patients extra medication just in case to avoid to seeing the patient again or writing for refills. This is an obvious problem that leaves a lot of left over medication and patients hold on to it.”

Dr. Paul Moore, professor of pharmacology and anesthesiology at the University of Pittsburgh School of Dental Medicine, says as many as half of all dental patients will get effective relief from an over-the-counter pain medicine like ibuprofen or acetaminophen. The dentist’s dilemma is not knowing which patients those are.

“Maybe 50 percent of the patients will need a prescription,” says Dr. Moore. “We just don't know which 50 percent and we have to provide a prescription for people who may or may not need it.”

Brittany Ringersen
3-year-old Brittany Ringersen (left) and cousin Samantha (right) playing.

To combat the rising opioid epidemic, a few dental schools are changing their training curricula. At the University of Pittsburgh School of Dental Medicine, students are trained to give their surgical patients a detailed explanation of the best way to take and dispose of medication. They write two-week prescriptions for powerful opioids that are not refillable.

“I think we find today that prescribing needs to include both education as well as dispensing,” say Dr. Moore. “We teach all of our students here if you're going to write a prescription for an opioid it is important to follow our checklist that includes the kinds of information that you need to provide that patient.”

For four years, Ringersen struggled to break her cycle of opioid addiction, until she hit rock bottom and entered inpatient re-hab. Now seven years clean and sober, Ringersen has gone from user to entrepreneur. After graduating from college, she started the Lighthouse Recovery Institute in Del Rey Beach, Florida. She works with young patients, many of whom got hooked on painkillers that a dentist prescribed. She sees the struggles and identifies with them because she’s been there. But most importantly, she knows the answer must include doctors and parents working together.

“I think we can see the corner and we are not quite turning it yet,” says Ringersen. “There is a lot more work to be done and the educational piece where we educate physicians on what to prescribe and families on what to look for is important. It is okay to confront your child on drug and alcohol experimentation.”