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Add your voice to help us increase awareness about prescription sharing.
Complete the survey below and get a $10 Amazon gift card!*

* The first 100 respondents who complete the survey will receive a $10 Amazon gift card. Respondents must be 18-25 years old, live, work or attend school in Fayette or Washington County, Pennsylvania and provide their email address to be eligible.

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Introduction

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You just had surgery. Acute pain after surgery will get better as your body heals. Over-the-counter medications, like ibuprofen and acetaminophen, can be effective for pain relief following most dental procedures. Still, there is no one-size-fits-all approach to managing pain.

To help your doctor, dentist or surgeon decide what course of action is right for you, make sure to update your health history form, talk to your doctor about medications you are currently taking, and don’t be afraid to ask plenty of questions! You can even include your primary medical doctor into this conversation. If you are in recovery, or have had an addiction in the past, tell your doctor. Also let your doctor know if anyone in your family has experienced addiction.

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What exactly are opioids?

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Opioids are natural or synthetic chemicals that relieve pain by binding to receptors in your brain to reduce the intensity of pain signals that reach the brain.

Commonly prescribed opioids include:

  • Hydrocodone (Vicodin)
  • Oxycodone (OxyContin)
  • Oxymorphone (Opana)
  • Morphine
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What should I ask my doctor if I’m prescribed an opioid after surgery?

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You are entitled. You are encouraged. You SHOULD ask questions so that you understand the risks and benefits of using opioids.

You can take charge of your recovery from this surgery. Here’s some questions that you should ask so that you’re aware of the purpose of the opioid prescription.

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NO! Opioids are just one modality that can reduce pain after surgery. There are MANY other options that have actually been shown to work with FEWER side effects. Ask your doctor about the following non-opioid treatment options:

  • Over-the-counter (OTC) medications like acetaminophen (Tylenol), ibuprofen (Advil), and naproxen (Aleve).
  • Application of heat or ice.
  • Physical therapy, acupuncture, or massage (if appropriate for a dental surgery)
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While opioids can provide relief relatively quickly, they probably won’t relieve all of your pain. The goal of any pain treatment is to SAFELY REDUCE PAIN, and INCREASE YOUR ABILITY TO DO EVERYDAY ACTIVITIES.

Make sure to ask your doctor what kind of pain relief and improvement you can expect overall. Will you be able to eat hard foods without your mouth hurting? Will you sleep better because your mouth pain has subsided?

Most prescription opioids have side effects like sleepiness and dizziness. Even if you take an opioid exactly like the doctor has told you too, there is still a risk of tolerance (where you would need more of the drug to produce the same effect) and physical dependence (where you experience withdrawal when the drug is stopped).

The following are commonly reported side effects that you should talk to your doctor about so you know what you may experience:

  • Increased sensitivity to pain
  • Constipation
  • Nausea and vomiting
  • Dry mouth
  • Sleepiness
  • Itching
  • Depression
  • Confusion
  • Dizziness

Additionally, when taking opioids, they may affect your ability to safely operate a vehicle. Please make sure that you know how the opioids affect you before proceeding with driving.

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If you absolutely need opioids to manage your pain, your doctor should prescribe the lowest possible dose. Believe it or not, a prescription for three days or less will often be enough.

Taking opioids for more than three days can increase your risk of addiction. If you’re still in pain after three days, make sure you have a follow-up appointment scheduled with your doctor so that they can reevaluate your pain. They may suggest using over-the-counter medicines or other non-drug ways to ease your pain, such as heat or cold therapy.

As a rule of thumb, opioids should only be used when necessary, and only for as long as necessary.

If you happen to need to take opioids for more than a few days, make sure you have a follow-up appointment scheduled with your doctor so that they can reevaluate your pain.

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GREAT QUESTION! Any time that you are given an opioid prescription, it’s a good idea to also ask for a prescription for naloxone, which is also known as its brand name Narcan. Learn more about the standing order for naloxone.

Think of it this way: we don’t exactly have fire extinguishers because we plan on putting out fires all day every day. We have them so that we can use them when we need to. Same goes for naloxone: you aren’t expected to overdose, intentionally or unintentionally, when you use an opioid (legitimate or illicit), but in the case that you forgot that you already took your prescribed dose and doubled up, or your little cousin got into the medicine cabinet, it’s always good to have naloxone on hand.

Signs and symptoms of overdose include:

  • Small, constricted ‘pinpoint pupils’
  • Falling asleep or loss of consciousness
  • Slow, shallow breathing
  • Choking or gurgling sounds
  • Limp body
  • Pale, blue, or cold skin
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Overdose and Sharing Meds

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Now that you’ve talked to your doctor about the basics, let’s talk about the deep stuff–preventing overdose and preventing others from accessing your medication.

It is incredibly dangerous to combine opioids with other drugs, especially those that cause drowsiness. For your own safety, you have to let your doctor know if you are taking any medications that might cause a dangerous interaction – you should know if there are any serious side effects.

Your risk of overdose increases when you combine taking opioids with:

  • Alcohol and/or other sedatives.
  • Benzodiazepines (maybe you’ve heard these referred to as ‘benzos’, like Valium and Xanax)
  • Other opioids (be it another prescription opioid, or an illicit one like heroin)
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ALWAYS store prescription opioids in a secure place, out of reach of children, family, friends, and visitors.

While at first thought, a medicine cabinet would be the most obvious and ‘safest’ place to store medications, it’s important to make sure that the medications are still completely out of reach.

The CDC recommends making sure that medicines are put up and away and out of reach and sight.

Make sure you put your medication away after every time you take it, and always make sure the safety cap is locked.

More information on the ‘Up and Away and Out of Sight’ campaign for safely storing medications can be found at upandaway.org.

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There are many drug-take-back programs in the area. To find one closest to you, please visit ddap.pa.gov.

If you are unable to take your extra prescriptions to a drug-take-back box, the FDA recommends flushing opioid pills down the toilet because they are risky to keep at home.

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While it might seem obvious to not share your prescription opioids with family or friends, sometimes people underestimate the dangers of sharing prescription stimulants like Dexedrine®, Adderall®, Ritalin®, and Concerta®.

Prescription stimulants are medicines generally used to treat attention-deficit hyperactivity disorder (ADHD) and narcolepsy – which causes uncontrollable episodes of deep sleep. Stimulants increase alertness, attention and energy.

Taking prescription stimulants for reasons other than treating ADHD or narcolepsy could lead to harmful health effects, such as psychosis, anger, paranoia, heart, nerve, and stomach problems. These issues can also lead to things more serious, like heart attacks and seizures.

Prescription stimulant misuse CAN lead to a substance use disorder – withdrawal symptoms of stimulants include fatigue, depression, and sleep problems.

If you share stimulants with friends, it is considered misuse. People misuse stimulants by taking them in a way that is not intended, such as:

  • Taking someone else’s prescription stimulant medication, even if it is for a medical reason, like ADHD.
  • Taking stimulant medication thinking it will improve your grades even though you do not have ADHD, as a ‘study drug’.
  • Taking more than the prescribed dose.
  • Taking a prescription stimulant medication in a way other than prescribed—for instance, crushing pills, adding them to water, and injecting the liquid.
  • Taking the prescription stimulant to get “high.”
  • Mixing the prescription stimulant with alcohol and certain other drugs. A pharmacist can tell you which drugs are not safe to mix with stimulants.

For more information on the importance of NOT sharing prescription opioids, visit pastop.org/care. For more information on the importance of NOT sharing stimulants, visit drugabuse.gov.

 

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In Review

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You had your surgery. You talked to your doctor about the risks and benefits of getting an opioid prescription to manage your pain. You asked ALL of the questions you wanted and needed to make sure you are safely taking this medication, and always asked for clarity if you didn’t understand something. You found out about alternative ways to manage your pain. You know how to safely dispose of any opioids that may be left over from your prescription. You know that naloxone isn’t provided because your doctor thinks you’re going to overdose–it’s there in case you need to use it. You learned that no matter what, you should never sell or share your prescription opioids or stimulants.

Now it’s time to relax and have a smooth recovery!

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References

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Conversation Starters: if You Recently Had an Injury, if You Are Prescribed Opioids https://www.choosingwisely.org/wp-content/uploads/2018/02/Using-Opioids-Safely-After-Surgery-AUA.pdf

National Institute on Drug Abuse; National Institutes of Health; U.S. Department of Health and Human Services. https://www.drugabuse.gov/publications/drugfacts/prescription-stimulants

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