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Dentists should be aware that patients may seek prescriptions for benzodiazepines or opioids in order to misuse or sell those drugs.
Requests for benzodiazepines generally involve new patients who claim to be very apprehensive about dental treatment and who may display anxiety characteristics during their dental examination. They often inform the dentist that their previous dentist always prescribed ‘something to calm me down’ and that it was ‘the only way that the dentist could do any work on me’.
Dentists need to have a level of suspicion when receiving such requests, especially when patients identify drugs by name, or cannot recall or are unwilling to divulge the name and locality of their previous dentist. Contact with the patient’s previous dentist or their medical practitioner can assist in identifying the bona fide case from those seeking prescriptions for misuse. Also, prescription of one or two tablets only, rather than a full pack, can be helpful to avoid misuse.
In Australia, the National Drug Strategy Household Survey 20131 identified misuse of analgesics as showing the largest increase between 2010 and 2013 of all drug types surveyed. It found that 7.7% of people in 2013 had used them for non-medical purposes compared with 4.8% in 2010. Those seeking to misuse opioids may do so with over-the-counter medicines which combine codeine (12.8 mg) with ibuprofen (200 mg), and also codeine (15 mg) with paracetamol (500 mg). The most commonly misused prescribed opioid in Australia was a combination of codeine and paracetamol.1 Such combinations consist of codeine (30 mg) and paracetamol (500 mg). These drugs are recommended for the management of severe pain after dental treatment at adult doses of codeine (60 mg) plus paracetamol (1000 mg) given every four hours (to a maximum paracetamol dose of 4 g every 24 hours).2
Patients who are seeking opioid prescriptions may claim to have severe dental pain, may present with self-inflicted intra-oral injuries, or may even deliberately irritate extraction sockets or ongoing root canal therapy. Dentists need to be suspicious of patients who wish to have ‘drug-only’ treatment and either refuse or are not interested in non-drug treatment. The Box shows suggested responses to a patient seeking drugs.
‘The drugs you are seeking are not appropriate for your particular problem. I think you should discuss this with your medical practitioner (I could contact them if you like), or if your pain is very severe, perhaps you should attend hospital.’
‘I do not prescribe the drugs you are seeking. I think you should discuss this with your medical practitioner (I could contact them if you like), or I could refer you to a specialist who manages anxious patients.’
Conflict of interest: none declared