Concerns about opiate use after wisdom teeth extraction

I have scheduled my college age daughter's wisdom teeth extraction for late summer. In the past 5 years (starting at age 16) she has had 4 surgeries (3 for ACL reconstruction, and 1 for sinus) and every time she has had Oxycontin. While there has been no sign of her not taking them as directed or abuse, I am very concerned about her using them.  She has a very low pain tolerance and feels that she "needs" these meds for post operative pain. I recently read a WaPo article which said that even one course of opiates used for wisdom teeth extraction could result in abuse or addiction and that studies showed that tylenol and advil were more effective in reducing dental pain. So I called the oral surgeon office ahead of her appointment to voice my concern and asked if they might make the argument to her when we came in about using the analgesics instead of narcotics. The person I spoke to said their office had seen the same article, and while their office still regularly prescribed the narcotics, there were some oral surgeons that wouldn't.  They said would make a note in her file. 

During the appointment they asked her about narcotics and she said that Oxy worked for her.  So I brought up the info in the article and everyone listened, and while my daughter said she might be willing to try just the analgesics, she then again said she had a low pain tolerance.

Is it fair of me to feel that just because of the risk of addiction and with so many previous surgeries having used opiates, that maybe it is not worth the risk and that she should endure a couple days of pain to avoid some possible long term negative outcome?  Does anyone have any previous experience, advice or perspective on how to deal with this situation?  Part of me thinks I shouldn't worry so much, but I'd hate to find out a year from now that I have a kid addicted to opiates after all of these surgeries because the medical professionals were reluctant to change their practices in light of the info?

[Moderator Note] a similar question was asked last year. See "Norco prescription for wisdom teeth?"

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I agree that this is a serious issue. My young adult daughter and I have both been offered narcotics for pain following medical procedures and we both have never accepted, opting for advil, pain, and rest instead. Since your daughter has already said she wants the Oxy, my advice is to try make sure she gets only enough for two days, and go with advil after that.

It’s true that millions of people became addicted to opiates because of wildly inappropriate prescribing. However, I worry the baby’s in danger of being thrown out w the bath water these days! They are so effective against pain that I believe there is a place for them, with a limited number of pills and caution. I’ve taken opiates many times during my life and am thankful for them and never became addicted.

I am appalled that in this day and age, "respected" oral surgeons remain so nonchalant about routinely prescribing opioids. Last year, my son (in his early 20s) had a slightly impacted wisdom tooth pulled.  Even though the procedure was a simple "pull out" extraction (not surgery; no actual cutting), there was no discussion about options for appropriate pain relief.  He was given their standard default Rx - antibiotics prophylactically for a few days, and narcotic pain relief.  I brought up the article(s) you mentioned, and asked about about possibly using alternating ibuprofen (Advil) and acetaminophen (Tylenol) instead, saving the narcotics RX unless absolutely needed, and was basically told we could "try that if we want."  No recognition of the evidence, no recognition of the risk of addition, (especially higher risk young men; he wasn't even asked about history), or anything.  Not even an awareness or recommended protocol for the analgesics. In the end, he took a  dose of each of the two non-narcotics once, took one more Advil at bedtime "just in case," and that was it.  The assumption that he would definitely NEED high-powered narcotics (which evidence actually is now showing are generally NOT better for this kind of pain) was, I thought, just completely unethical  I keep meaning to write them about it, but still haven't made myself do it.  Maybe after this, I will.  

I have had some pretty major surgeries (oral and body) and after observing my sister become addicted to opioids (for many years in pill form but now combining with marijuana and sometimes mixing with alcohol - and also with antidepressants), I am afraid of any painkillers. My husband is a physician who basically makes a salary from prescribing them (don’t worry, he almost never prescribes them so his monthly pay makes it hard to afford rent); he’s extremely fearful of perpetuating a big problem in our country. In his words, “3-7 days of painkillers after a surgery...then start weaning.” And, “when you hit your deathbed, that’s a better time to hit the meds hard if you desire.” There’s a major distinction between the two but we often don’t see it. I’ve had six major surgeries and bad accident and have taken three days of Vicodin and I’m done. I was also encouraged by my husband to take the medications for proper pain management. The difference in my situation - he, a medical doctor, guided me every step of the way, and did so in a way he could never do with patients. There’s a fine line and we have haven’t been made aware of the nuances.

I would say if/when this comes up with our kids, I am going to prep them (they’ve seen plenty of the destruction in SF with those taking to the streets as a result of their addiction or not managed mental health, many of whom take refuge in seeking out drugs as an understandable escape). We talk to our children  about how human beings get there (addiction is likely do to unresolved trauma and a longing for connection). Constant dopamine hits (technology, sugar, social media, alcohol, etc are the fuel for dopamine) are destructive and make it harder to deal with the root causes of our issues. We tell our kids we ALL have issues so they know we are all susceptible and not alone. Once their teenage brains reject this (our eldest is 11), we will tell them that drugs are so amazing (not bad) that they hijack your brain: “Do you want this to happen?” is what we will ask. Then, help them immediately get off of crutches, whether real crutches or other crutches given to us in life that are intended for situational help. That’s how we view painkillers -  for the use pain for a period of time. Not for a lifetime. I’m going out on a limb here and I will say that anyone who is on medications that work on the same receptors as opioids are going to have a harder time (meaning longer but not impossible at all) kicking the habit. Opioids are known to be amazing, which is why many can’t imagine living without them. There’s no sense in demonizing them. Like a car that has the ability to hurt someone, when used right, it can is from point A to point B, but we are always taking a risk behind the wheel & trusting other drivers. When we enable use of something as powerful as many kinds of drugs, we might be handing our loved ones and friends a lifetime of misery or even death. 

 I would say that this is a good time to be concerned but also understanding of your daughter (which you seem to be) and where she is. You are her guide and she will make decisions. I think our job as parents to provide our kids with the information we have. 

Depending on how complicated the teeth extraction will be (for example are they impacted?), the pain may not be as bad as she fears, even with low pain tolerance.  My middle school age child had to have wisdom teeth removed.   Prescription acetaminophen was all we got, it seemed to work fine, and the pain went down within two days.   Has your daughter ever used high dose tylenol or advil? (dose as prescribed by doctor).  It may work much much better than she expects!

I alternated tylenol and advil for a few days, and although it didn't take away all the pain, it was enough.