Doctor Eclectic

Doctor Eclectic
Doctor Eclectic

Tuesday, June 2, 2015

Heroin

For the last fourteen years the American Association of Maxilla-facial Oral Surgeons (AAMOS) has held meetings with interested stakeholders for their services in conjunction with a Dental Consultant’s Meeting I attend (AADC).

Lately, those meetings have been held on odd-years (pun recognized but not intended), this year outside of Albuquerque.  I was invited and indicated interest in recent proposed codes for sedation in conjunction with third-molar extractions.

That topic made the Agenda, but the surprising one to me was “How AAMOS plays a role in Heroin addiction.”

It shouldn’t have been that surprising.  NPR recently spent a week on the increase in Heroin addition, particularly in small towns and in conjunction with returning veterans.  A movie titled, “Heaven Knows What” is stirring interest prior to its release next week. And most of this coverage concluded that Heroin addiction was the consequence of addicts being unable to afford or obtain prescription opioids.

But is that accurate?  And if so, what is the easiest, cheapest, and most productive way to make inroads into the statistic?

Through the week, NPR looked at several different scenarios:  small or mid-sized towns in the Midwest, where unemployment and dead-end job prospects cause many of the young to lose heart and hope; urban and suburban areas where small-time players in Mexican drug distribution are finding a ready market for cheap heroin and an opportunity to pilfer 501 Levi Jeans from the local Walmart to take home to family and friends; some Veteran Hospitals where medicinal opioids are routinely prescribed over time to veterans who would otherwise require intensive care for their PTSD, and the over-prescription of opioids for chronic pain control.

This last was the focus of the Oral Surgeons at the AAMOS Meeting.  Most have a protocol of preventive pain abatement, namely, prescribing pain medication before the local anesthesia used to mask pain wears off.  This is nothing new, as I used the same regime when I was acting Oral Surgeon at the New London Dental Clinic.  I removed more than 1,000 wisdom teeth in about five months and routinely prescribed a three-day dose Vicodin.  How many of my patients actually needed this dose or how many actually used the entire prescription I could not say.

I do know that the potency of the medications has increased, as have the occasions for their prescription.  Mary and I are growing older and have more surgical procedures. In her case she had shoulder surgery and was prescribed oxycodone, partially because of its time-release feature makes compliance more predictable. I had Prostate surgery, and a hip replacement both of which resulted in some heavy medication prescription.  Neither of us are inclined to take medication without cause and consequently had large amounts of medications in our medicine cabinet.

Sometime past, a relative, who happens to be a pharmacist, noted oxycodone in our medicine cabinet and asked us, “Do you know the street value of that?, which we didn’t.  Interestingly when he mentioned that we noticed that about half the prescription had gone missing.  Our best guess is that the cabinet had been raided when our son had an unsupervised party.

And that was the explanation given by the AAMOS President, when asked what happens to those extra drugs?  He said many of them end up in Pharma Parties, although Wikipedia doubts the existence of those parties

Whether or not Pharma Parties exist is less significant to me than how do we get rid of those pills without polluting our waters or seeing them appear on the streets, and I asked the question, “Why do we make recycling as difficult as we do?”

The AAMOS Executive Director said that, while some pharmacies are allowed a fee to collect and render harmless medications, most Police and Fire Departments have a free drop-off, no-questions-asked program.

That may be true in her city near Chicago, but not so in my community.  The Fire Captain reminded me that my options are: pay the pharmacy, render the medications inert or poisonous and label them as such before placing them in as trash, or passing them off to the Hazardous Waste station.

Since I believe these are all unlikely to be normal for most households, I believe there should be a program to pay for turning in unused medications, much as we have programs that pay for turning in guns. BTW, this is the only approach that is quantifiable and affordable.  I hoped that this national problem gets some national support.

My next Post will be more light-hearted.  I’m calling it “Cognitive Chimps” and I think you will find it entertaining.  I hope to have you join me.

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