A New Painkiller Problem in the ER

If you develop an after-hours toothache and head to the emergency room in search of relief, you may have a hard sell on your hands. What’s the problem? ER docs are being inundated with fake patients complaining of tooth pain in hopes of scoring some prescription narcotics to feed their drug habit. This growing trend means that patients in legitimate pain may be turned away empty-handed.

Since many poor patients forgo preventative dental care because they can’t afford it, it’s not improbable that they could end up in the emergency room in extreme pain. But how do doctors tell those in need from the ones who are merely making the rounds, looking for whatever meds they can get? They can’t. As a result, most physicians err on the side of treating pain, knowing that route often leads to abuse.

It’s such a growing problem that for the first time, the frequent prescription of narcotics in emergency departments for dental pain is being studied in a research project financed by the National Institutes of Health.

From 1997 to 2007, painkillers were prescribed in three of four visits to the emergency department for dental complaints, according to a new analysis of the National Hospital Ambulatory Medical Care Survey. Over that period, the number of painkiller prescriptions for dental patients in emergency departments rose 26 percent, according to the report, published January 2012 in the journal Medical Care.

It’s a system that is likely creating more addicts, but many ER doctors feel like their hands are tied. They lack the diagnostic tools to determine if a tooth’s nerve is infected and they don’t have the training to provide alternative treatment methods, like a localized anesthetic injection, which can provide immediate relief for up to 16 hours.

Monitoring programs have been set up to help doctors determine whether patients have recently been given painkillers (40 states have these programs and eight have enacted legislation to create them), but they are not used often enough.

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