Recommendations for Patients and Dental Professionals in Recovery: Opioid Use Considerations for Surgical Procedures

submitted by 

Bill Claytor, DDS, MAGD-LLSR, FACD

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:

1. Strengthening the patient’s support network (sponsors, therapists, and 12-step groups), an
2. 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.

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:

1. Possession: Keeping the medication out of the patient’s reach and knowledge of its location.
2. Evaluation: Assessing the patient’s pain level objectively.
3. Dispensing: Administering the medication only if they determine it is necessary.
4. 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.