Dental professionals and their patients who are in stable recovery from substance use disorders (addiction), strive to safeguard their recovery by taking precautions to maintain their abstinence whenever possible. After undergoing surgery, the potential is present they may receive an opioid for post-op discomfort from their surgeon.
This article outlines suggested protocols and considerations for the patient who is in stable recovery undergoing medical or surgical procedures. A specific focus on managing pain while minimizing the exposure to opioids and other addictive medications will be given to reduce the risk for relapse.
This is YOUR healthcare. YOU are in control of your treatment. Be PROACTIVE!
(For purposes of this article, the dental professional (dentists and dental hygienists) and our patients will be referred to as “the patient” or “patients”. The following suggested guidelines are ideas for your consideration only and not to be construed as giving medical advice or recommendations.)
Pre-operative Considerations
The patient in stable recovery must take a proactive, empowered role in their own healthcare. Success in navigating surgical procedures without compromising stable recovery depends on a dual-track strategy:
Strengthening the patient’s support network (sponsors, therapists, and 12-step groups), an
Maintaining transparent communication with the surgical team. While intra-operative opioids may be necessary for physiological stability, the use of non-opioid alternatives for post-operative pain management is the goal. The most critical takeaway is the “controlled dispensing” model, i.e., if opioids are absolutely necessary post-surgery, they should be managed and dispensed by a trusted third party rather than self-administered by the patient.
Pre-Surgical Protocols and Preparation
Before undergoing any medical or surgical procedure, individuals in stable recovery are advised to engage their support systems and healthcare providers to create a safety net.
Engagement of Support Networks
Sponsor Consultation: The patient should contact their sponsor immediately to discuss the upcoming procedure and potential triggers. A sponsor can be a great resource and comfort to share your fears and concerns about the upcoming surgery.
Increased Support Density: There is a recommendation to increase attendance at 12-step recovery meetings. Patients should explicitly share their upcoming surgery within these meetings to garner support.
Professional Notification: Patients must inform their therapists, counselors, treatment centers, or Intensive Outpatient Programs (IOPs) of the scheduled procedure. Being honest and being upfront about the pending surgery and the potential you may receive an addictive substance are always guidelines to follow to increase your support and protect your recovery.
Communication with the Surgical Team
Patients are encouraged to be proactive and transparent with their surgeon and anesthesiologist. Key discussion points include:
Status Disclosure: Clearly stating that they are in stable recovery.
Substance Minimization: Expressing a firm desire to minimize the use of opioids and other mood-altering substances.
Intra-operative Necessity: Acknowledging that the use of opioids or mood-altering medications by an anesthesiologist during surgery if necessary is generally acceptable to maintain physiologic stability.
Post-Surgical Pain Management Strategies
The document prioritizes non-opioid interventions and provides a hierarchy of pain management options for your consideration to avoid the “addict brain” response to narcotics.
Non-Opioid Pharmaceutical Alternatives
If there are no contraindications, the primary response to pain should always be non-narcotic.
Medication Type
Examples / Specific Instructions
First Response
Ibuprofen combined with Acetaminophen.
Other NSAIDs
Naprosyn; Ketorolac (Toradol) – typically an IM loading dose followed by oral (po) doses.
Non-Addictive / Non-Opioid
Journavx (Suzetrigine) for moderate to severe pain.
Long-Acting Anesthetics
Exparel (Bupivacaine Liposomal Injection Suspension) – provides relief for 36 hours (max), dissipating over 96 hours.
Other Options
Zynrelef; EnduraKT
Physical and Holistic Interventions
Standard physical recovery protocols should be utilized where appropriate:
Ice and heat application.
Saline rinses (for dental procedures).
Elevated rest.
Protocols for Opioid Use
While the preference is to avoid going home with an opioid prescription entirely, the document outlines strict safety protocols if narcotics are deemed medically necessary.
Filling and Using Prescriptions
Avoid “Just in Case” Use: Patients should never fill an opioid prescription for “rescue” or “just in case” purposes. This is identified as a risk factor for “addict brain” logic.
Necessity Only: Prescriptions should only be filled if absolutely necessary for acute pain management.
The Controlled Dispensing Model
If an opioid prescription is filled, the patient must relinquish control of the medication to a sponsor or a trusted loved one. This individual is responsible for:
Possession: Keeping the medication out of the patient’s reach and knowledge of its location.
Evaluation: Assessing the patient’s pain level objectively.
Dispensing: Administering the medication only if they determine it is necessary.
Duration: Ensuring opioids are used only for a specific need for a specific period of time.
Conclusion: Patient Empowerment
The overarching theme of the recommendations is that the patient, whether a layperson or a dental professional, is in control of their care. Being proactive is the primary defense against relapse during medical transitions. By suggesting alternatives and involving a support network in the dispensing process, the patient maintains their recovery while effectively managing surgical trauma.
It has been nearly twelve years since I started my journey of being in recovery. I often think back of times I had negative happenings in life. In active addiction when those “not go as planned” moments happened, negative emotions like grief, anger, hopelessness, and simply choosing not to accept reality was my life at that time. In choosing not to accept reality, I chose to numb down the feelings I had and using substances got me there quicker. In using, life got more out of control and the cycle of feeling let down, becoming angry and not dealing with life occurrences led to not healing but self-sabotaging.
Recovery on the other hand led me down a path of working on myself through abstinence, accountability, therapy, and a twelve step program to learn to manage my emotions, learn life skills that allowed me to mature, and mostly not use mind or mood altering substances so I could feel, deal, and heal.
I could write a book on all the traumatic things that occurred in my life and one could see how easy substance abuse was the option I chose not to accept those things. Most people in recovery agree that life will show its ugly side, sometimes to the point of misery, but abstinence helps us deal with life on life’s terms. When I get in my head about negative feelings and things that happen, I can use tools I have learned to be present, clear-headed, and power through what has occurred. I learned that most things in life are not as bad as I imagined and I can also be an example to my children of how to make healthy choices in life.
I am forever grateful for my recovery. I am grateful to the God of my understanding who has plans to prosper me, to give me hope and a future. My choice today is to continue to learn skills that help me have serenity, accept the things I cannot change, and ask for wisdom to know the difference.
I am grateful that I reached a point whereby I was willing to consider I was an alcoholic. That willingness opened doors of opportunities and insight that eventually lead to accepting that I am an alcoholic. Once I accepted that I was alcoholic my life changed.
I was no longer a mental prisoner to the idea that I could never drink like a normal again. I was no longer an emotional prisoner thinking that I was defective. It just is. I am alcoholic. I accept I have a genetic disease. Now I can live joyous and free from the plague of shame and negative self-value and worth. I am no longer anxious. As my brain healed and my sleep improved, I gradually became more calm and secure with myself and with others.
In the beginning I didn’t feel comfortable at meetings. I believed I was different and, if I am being honest, there were times I thought I was better than the others attending the meetings. As I attended more meetings, I began to relate and see commonalities. As I came to accept that I belonged, I was gifted with community. Genuine unconditional relationships. I went from an insecure loner to a confident supported individual comfortable in her own skin. Through acceptance I have found humility that allows me to be right-sized and as a result I am far less judgmental.
My life changed dramatically when I relinquished control. Once I let go and let God, my life as I knew it did a complete 360-degree turn around. To accept that I cannot control others was a profound realization. To live my life on life’s terms without motive, expectation, and self-sabotage was enlightening. I became a better version of myself, more calm and less reactive. By recognizing I cannot control every outcome, the anxiety of micromanaging my life diminished. In essence, my distress stems not from the event itself, but from my judgment of the event.
When I accepted God is in control, I became better able to negotiate life. As I became better able to negotiate small events, I became better equipped to handle major life events. Today I am equipped to differentiate ordinary annoyances from major disruptions. I am able to view minor setbacks not as failures but as protective or redirecting events. With faith, acceptance and an open mind inconveniences can lead to positive outcomes. I am more resilient today because my mindset has shifted from frustration to curiosity and acceptance.
The setbacks in daily life can be the catalyst for finding inner strength, leading to less focus on external outcomes and more control over our reactions. By turning things over to my Higher Power I am a better version of myself and others respect me. I like myself better. I have a better chance of loving others and being loved.
None of these changes occurred quickly or suddenly. I put in a lot of work and because of that action a metamorphosis occurred. I have learned the benefit of the power of building good habits through action. After all, we become what we do. These changes and levels of acceptance in my life dovetailed one another. My life changed because I changed and you can too. Do you think you can accept that?
When I first started on my recovery journey, one of the first underlying principles that I learned of was acceptance. At that time, acceptance to me was being willing to admit that addiction is a disease and that my condition would not improve unless I could accept that I could no longer use alcohol or other mind-altering substances. This was not an easy concession to make at first, despite my track record while actively using. At the time, it didn’t occur to me that my anxiety at work, failed relationships, and general unhappiness stemmed from my disease, even after two DWIs and several other instances of poor choices influenced by my drinking. I was simply dealing with bad luck, personal issues, and other misfortunes and I saw alcohol as a means to help me cope. Finally, after becoming involved with CDP and pursuing recovery I learned the true nature of my spiritual condition and gained acceptance of my inability to drink successfully.
While I saw a marked improvement in the quality of my life once I embraced sobriety, I still found myself dealing with anxiety and feelings of inadequacy in my social and professional life. Though I found myself with multiple years of sobriety on two different occasions, I ended up relapsing both times after a period of detachment from friends, family, recovery groups, and the tools that had led me to success previously. Despite my efforts there was still something missing that I had apparently not addressed. After my most recent treatment experience, I came to discover that while I had accepted my disease and condition years ago, I had still not fully accepted myself for who I am. I found myself becoming aware of insecurities I had not realized were there, false beliefs I had of myself that weren’t true, and an inability to forgive myself for previous actions when I was still actively drinking. Even though I was in a better place in life overall, I still blamed myself for things that had happened and could not escape that shadow. Through the professionals, colleagues, and friends I have met and utilize in recovery, I can now face those demons that still plague me.
Even though it was depressing at first to find myself having to rebuild what I once had, I have been able to turn it into a true turning point in my recovery. I am addressing the traumas and mistakes that I never truly forgave myself and others for, and becoming a more open and honest person because of it. Recently I’ve dealt with big changes at work involving employee turnover, and the stress of that situation would easily have driven me into a dark and dangerous place as recently as a year ago. However, because of my renewed focus on acceptance, I have faced the challenges as they have presented themselves, and not only have I withstood the tests but I have become a stronger and more confident provider because of them. Rather than hide my shortcomings and try to work around them, I now accept them as they appear, deal with them properly, and learn from those experiences to be a better professional and a better person overall.
Accepting the limitations imposed by my alcoholism marked a transformative juncture in my life. For years, I clung desperately to the notion that I could maintain my drinking habits while pursuing my dreams. I was convinced that I could live the life I desired, keep my career on track, and achieve the respect I longed for. However, the unyielding grip of alcohol transformed my aspirations into mere illusions, leading to a cycle of disappointment and despair.
The realization that I could not achieve the life I envisioned while continuing to abuse alcohol was a painful but necessary awakening. It was in confronting this harsh truth that I discovered the strength to change. I recognized that my addiction had erected insurmountable barriers between me and my dreams. It was a sobering moment of clarity—one that allowed me to take the first steps toward recovery and personal growth.
A pivotal moment in my journey was my involvement in the North Carolina Caring Dental Professional Program. This program provided me with the support, resources, and guidance I needed to enter recovery. The program’s emphasis on compassion and understanding helped me confront my addiction seriously, reminding me that I was not alone in my struggles and that healing was possible.
Once I accepted this reality, my life began to unfold in ways I had never imagined. Marrying a wonderful woman brought immense joy and stability. Together, we blended our families, creating a supportive environment that fostered love and healing. My new family was a testament to the possibilities that emerged after I put down the bottle. This union has not only enriched my life but has also provided a strong foundation built on trust and mutual respect.
My journey to sobriety also introduced me to a network of friends who share a common bond through our collective struggles. Together, we discovered a passion for outdoor activities that reignited my sense of adventure. The breathtaking landscapes of Italy and the stunning trails across the United States became our playgrounds. Biking and skiing not only supplemented my physical health but also nurtured my mental well-being, reinforcing the belief that life is meant to be lived fully and passionately.
Practicing the principles of Alcoholics Anonymous (AA) has further deepened my commitment to sobriety. The support I found within this fellowship proved invaluable in regaining the respect of my community and profession. Through open discussions, shared experiences, and understanding, I learned to rebuild what had been lost. The connections I forged within AA reinstated my faith in myself and helped me recognize the importance of surrounding myself with uplifting and sober individuals.
Even after fourteen years of sobriety, I faced a temporary relapse. However, the NCCDP offered support again during this challenging time, helping me navigate my setback and find my way back to recovery. That experience underscored the importance of vulnerability, reminding me that recovery is not a linear path but a journey that requires continual commitment.
Today, with eight additional years of sobriety under my belt, I celebrate not just the absence of alcohol but the richness of life that has been reestablished through acceptance and change. I now embrace each day with gratitude and determination, knowing that the life I once thought was unattainable is now my reality. My story is a testament that accepting limitations can lead to extraordinary transformations, and that true strength lies in the willingness to confront one’s flaws and embrace the journey of recovery.
Kratom, derived from the leaves of a Southeast Asian tree, contains active compounds such as mitragynine and 7-hydroxymitragynine (7-OH). Although sometimes referred to informally as “legal morphine,” Kratom currently has no FDA-approved medical use in the United States. Despite this, it is widely perceived by the public as a dietary supplement. Between 2022 and 2024, U.S. use of Kratom products increased significantly—by an estimated five- to eight-fold—with current user estimates ranging from 11 to 16 million people and retail sales exceeding $2.2 billion annually.
In 2016, efforts were made to classify Kratom as a Schedule I substance, indicating high abuse potential and no accepted medical use. The American Kratom Association (AKA) urged federal agencies to postpone scheduling to allow further research. As of today, Kratom is not scheduled federally, but it remains on the DEA’s “Drugs of Concern” list due to ongoing safety questions and reports of misuse.
Relevance to Dentistry
Many dental patients may be using Kratom, and its pharmacologic effects are clinically important. As with other substances—including tobacco, alcohol, opioids, cannabis, and vaping products—providers should include Kratom in routine substance-use histories. Three essential questions can guide this conversation:
What substance are you using, and how is it taken? (e.g., smoking, vaping, pills, extracts)
How frequently do you use it? (e.g., number of times per day or per month)
Have you experienced any consequences related to use? (e.g., employment issues, legal problems, missed responsibilities)
Question 3 is particularly important, as reported consequences may indicate escalating use, dependence, or potential addiction.
Pharmacology and Risks
Kratom acts as a partial μ-opioid receptor agonist, which explains both its stimulant effects at low doses and opioid-like effects at higher doses. The metabolite 7-OH is especially potent—estimated to be 30–40 times stronger at opioid receptors than mitragynine—and is associated with analgesia, euphoria, respiratory depression, dependence, and withdrawal. Although commercial Kratom products should contain less than 2% 7-OH, some extracts have been found with significantly higher concentrations, raising concerns about potency and labeling accuracy.
Kratom is sometimes used by individuals attempting to self-manage opioid withdrawal or cravings. However, this practice carries risks, and withdrawal symptoms from Kratom itself have been reported. Currently, no FDA-approved treatment exists specifically for Kratom dependence, though buprenorphine (Suboxone) has shown effectiveness in reducing withdrawal symptoms in some cases.
Summary
Kratom is a widely used but incompletely understood substance with pharmacologic actions similar to prescription opioids at higher doses. While not federally scheduled, it carries documented risks of dependence and withdrawal. Because its use is increasingly common among the public, dental professionals should routinely ask patients about Kratom use, recognize its potential impact on health and treatment planning, and be aware of its possible interaction with opioid-based pain management strategies.
Gratefulness is more than a feeling for me—it’s a daily practice and a way of living. When I look back on the person I was before recovery and compare her to who I am today, I am overwhelmed with gratitude. I have been sober for eleven years, and those years have taught me that recovery is not just about abstaining from substances; it’s about rebuilding a life with integrity, purpose, and peace. My recovery has changed every part of my future, personally, professionally, and spiritually.
When I first began the journey of recovery, I couldn’t imagine living one day at a time, much less eleven years. My life back then felt unmanageable, and hope seemed distant. But through the support of programs, people, and faith, I began to see that healing was possible. One of the biggest blessings along the way was the North Carolina Caring Dental professionals program. This organization not only helped me navigate the difficult early stages of recovery but also reminded me that my career as a dental hygienist could still have meaning and purpose. They offered guidance, encouragement, and accountability, tools that helped me rebuild my professional reputation and restore my confidence. For that, I will always be grateful.
Being a dental hygienist in recovery has deepened my compassion for others. I’ve learned to meet people where they are, to listen without judgment, and to show kindness in every interaction. Many patients come to dental visits anxious or ashamed, and I understand those feelings because I’ve been there. Recovery has taught me empathy, humility, and the importance of service, values that I now bring into my work every day. My career no longer defines my worth; instead, it provides a platform to share hope and positivity with others.
Gratefulness also fills my personal life in ways I never expected. Today, I wake up with a clear mind, a steady heart, and the ability to show up fully for the people I love. I am thankful for family members and friends who stood by me during my hardest times, and for the chance to make new memories with them. I’m grateful for quiet mornings, meaningful conversations, laughter, and even life’s challenges because they remind me how far I’ve come. Gratitude has taught me to slow down, appreciate the moment, and focus on what truly matters.
Recovery has changed my future by giving me the tools to live in the present. I no longer worry about what I’ve lost, but celebrate what I’ve gained: honesty, serenity, and a renewed sense of purpose. Every day that I remain sober is a gift, and with that gift comes responsibility to keep growing, to help others, and to stay grateful. My future is brighter not because everything is perfect, but because I have learned to appreciate the imperfect beauty of each day. Today, I am not only sober—I am free, fulfilled, and thankful beyond measure.
Looking back on my personal condition prior to starting my recovery journey, I realize what a difference gratitude has made in every facet of my life. Prior to getting sober I was consumed by negativity, both in my personal and professional lives. I only saw my self-worth in terms of what others thought of me, my accomplishments in the workplace, and what material possessions and wealth I had obtained. No matter how hard I worked, however, I couldn’t appreciate what I had done. Instead, I could only see where I had fallen short of my expectations. I always wanted more, but no matter what I gained it couldn’t remove the feeling of inadequacy I felt at everything I tried to apply myself to. Soon I was dreading going to work, dwelling on how I would inevitably fail at what was expected of me. I had been drinking regularly since college, but at this point it became less of a means to relax and fit in and more of an escape from my presumed failures and shortcomings. After a few years I found myself going through a divorce, drinking to excess daily, struggling financially, mired in toxic relationships, and feeling more worthless and incompetent than ever. Once my legal and professional troubles led me to the Caring Dental Professionals, it only cemented in my mind that I was an abject failure at life.
Slowly but surely though, the path to recovery started to change how I perceived myself and everything around me. I began to realize that I wasn’t just learning to live without drinking, but that I was learning how to deal with the fears, insecurities, and resentments that had sabotaged my happiness and well-being. Through working the steps and confiding in others, I realized that I was not a failure or disappointment, but rather that my negativity and inability to see the good qualities inside myself were holding me back. As I continued to work on my defects of character, I began to take note of all the things in my life that should be truly thankful for. I started to truly appreciate the support of my friends and family, my continued employment despite personal issues, and my improved physical, mental, emotional, and spiritual health. My worries of what problems lurked my future started to be replaced with a knowledge and acceptance that no matter what lay in store for me, I would be able to overcome it as long as I continued to work on myself and find joy in the gifts of today.
Now that I have a renewed focus on my goals for living and what things are truly important to me, I’m able to appreciate the things I used to take for granted. Instead of being weighed down by anger, guilt, and fear I can deal with adversity responsibly and in a timely manner, without having to resort to alcohol or other destructive behaviors to numb the pain. Instead of dwelling on past mistakes I can see how those events have shaped me and what I can learn from the person I was back then. Instead of seeing problem on the horizon, I see challenges that will make me a stronger and wiser person in the future. Being able to find gratitude not just for the rewards of the present but in working through the struggles of the past and having the tools to work through anything that might arise in the future is a true indication of how far I’ve truly come.
Being in recovery has given me so many blessing. Most of all, it has given me the ability to have a positive outlook on life and my future.
Prior to recovery, I struggled with shame and ruminating thoughts. Whenever something did not work out as I thought it should, I would spend countless hours “ what iffing” the situation. I would waste so much energy running the situation over in my mind. “Well if only I could have, well I should have, if only!”
Today I am so grateful that I have grown spiritually. Sometime in my recovery path, the ruminating thoughts ceased. I noticed that I no longer obsessed over things beyond my control. I had unconsciously turned all over to my Higher Power and “let go”. What a relief. Today, I am assured that my Higher Power has my best interest at heart. I do not need to know the how or the why of events. I only need to trust that the outcome is going to be the best for me. This does not mean that my life is free of struggles. I just have an opportunity to be willing to trust in my Higher Power and wait to see what will be revealed.
Additionally, in recovery I have learned that I can start my day over anytime I please. Prior to recovery, I would feel stuck in a negative pattern that may last for days or weeks. What a relief to learn that all I had to change was my attitude and that I could change this at anytime. This seems like such a simple concept, but one that was difficult for me to grasp. I am so grateful that I finally became willing to see this as an option to living a happy, healthy, life.
Finally, I am grateful to have the friends that my recovery network has provided. Prior to recovery, I lived in isolation. My life is so full at present. I have friends in recovery that I have a deep connection with. I am able to be a friend and to have friends. These relationships make my life full and for them I am so grateful.
In recent years, the conversation around mental health and professional burnout has grown louder—and rightly so. Dentistry, while deeply rewarding, is also one of the most demanding professions. The pressures of clinical precision, patient care, business management, and personal responsibilities can take a toll on even the most resilient professionals.
At NCCDP, we’ve always been committed to supporting the health and well-being of dental professionals across North Carolina. Historically, our focus has centered on substance use monitoring and recovery support. But as the needs of our community evolve, so must our response.
That’s why I’m happy to announce that NCCDP is expanding its scope to include comprehensive mental health and burnout resources—designed to support the whole professional.
🌱 What’s New?
• Mental Health Support
We’ve identified new licensed mental health professionals who understand the unique challenges of dental practice. Whether you’re facing anxiety, depression, compassion fatigue, or simply need someone to talk to, help is now more accessible.
• Suicide Prevention Training
In collaboration with the NC State Board of Dental Examiners, NCCDP will complete specialized training to help dental professionals recognize warning signs, respond appropriately, and connect peers to life-saving resources. This initiative reflects our shared commitment to reducing stigma and fostering a culture of proactive support.
• Burnout Prevention & Recovery Tools
Our support services include educational workshops, Zoom Meetings, and podcasts focused on stress management, work-life balance, and resilience-building strategies tailored for dental professionals.
💬 Why This Matters
Mental health is not a luxury—it’s a necessity. By expanding our services, NCCDP aims to destigmatize seeking help and empower dental professionals to prioritize their emotional and psychological well-being. We believe that a thriving dental community starts with healthy individuals.
📣 Get Involved
If you or someone you know could benefit from these resources, please reach out. Whether you’re struggling silently or simply want to stay ahead of burnout, NCCDP is here for you.
Together, we can build a culture of care, compassion, and resilience in North Carolina dentistry.
Lauren Haarlow, LCSW, LCAS, CCS Clinical Director North Carolina Caring Dental Professionals
