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An Introduction to Substance Use Disorders for Dental Professionals

Course Number: 545

Commonly Abused Prescription Drugs

Prescription Stimulant Misuse: In 2022, the National Survey on Drug Use and Health (NSDUH) assessed the misuse of prescription stimulants in the following categories:

  • Amphetamine products – often used for attention deficit hyperactivity disorder.

  • Methylphenidate products – often used for attention deficit hyperactivity disorder.

  • Anorectic products – used for weight loss.

In 2022, among people 12 and older, 1.5% of the US population misused prescription stimulants in the past year. The percentage was highest among young adults aged 18-25 (1.3 million) followed by adults aged 26 or older (2.8 million). Among adolescents aged 12-17, 226,000 reported misusing prescription simulants.

Misuse of stimulants can cause addiction and other health consequences. These include psychosis, seizures, and cardiovascular complications.42

Prescription Tranquilizers or Sedative Misuse: Prescription tranquilizers include benzodiazepine tranquilizers and muscle relaxants, whereas prescription sedatives include zolpidem products, benzodiazepine sedatives, and barbiturates. They are categorized together due to their common impact on specific activity in the brain.

In the year 2022, 1.7% (48 million people) reported that they misused prescription tranquilizers or sedatives. Benzodiazepine drugs can be prescribed as a tranquilizer for the relief of anxiety or a sedative for the relief of insomnia. Among those 12 and older 3.7 million individuals misused benzodiazepines in the past year.

These drugs are addictive and, in chronic users or abusers, discontinuing them abruptly without a physician's supervision can cause severe withdrawal symptoms, including seizures, which can be life-threatening.42

Prescription Pain Reliever Misuse:

Opioids (used to treat pain): Prescription opioids act on the same receptors as heroin and can be highly addictive. People who abuse them sometimes alter the route of administration (e.g., snorting or injecting) to intensify the effects. A study of heroin users identified three main paths to heroin addiction: Prescription opioid use to heroin use, cocaine use to heroin use (to come down), and polydrug use (use of multiple substances) to heroin use.48 It is estimated that approximately 3 million people in the U.S. meet the abuse or dependence criteria for prescription opioids. Abuse of opioids, either alone or with alcohol or other drugs, can depress respiration or lead to death. In 2021, 45 people in the United States died each day from a prescription opioid overdose, totaling nearly 17, 000 deaths (see Figure 11 below). Prescription opioids were involved in nearly 21% of all opioid overdose deaths in 2021.10,61

For more information about opioids, please see the following course on The Dental Professional’s Role in the Opioid Crisis.

Graph showing the US national drug overdose deaths involving select prescription and illicit drugs from 1999 to 2018.

Figure 11. National Overdose Deaths Involving Prescription Opioids*, Number Among All Ages, 1999-2021

While hydrocodone and oxycodone may be familiar prescription opioid analgesics that are also commonly abused, there are others which the dental healthcare provider should be aware:

Fentanyl is a synthetic opiate which is a powerful analgesic, like morphine, but can be up to 100 times more powerful. The legitimate use of fentanyl is generally limited to end of life pain management. Carfentanil is a derivative of fentanyl and can be 100 time stronger than fentanyl.

Due to the highly addictive nature of the opioid pain relievers, the dental practitioner should consider alternative non-opioid standard approved by the American Dental Association.

Table 1. ADA Oral Analgesics for Acute Dental Pain2

Anticipated Pain LevelOral Analgesic Options
Ibuprofin 200-400 mg as needed for pain every 4-6 hours
Mild to Moderate
Ibuprofen 400 to 600 mg fixed interval every 6 hours for 24 hours
Ibuprofen 400 mg as needed for pain every 4 to 6 hours
Moderate to Severe
Ibuprofen 400 to 600 mg plus acetaminophen 650 mg with hydrocodone 10 mg fixed interval every 6 hours for 24 to 48 hours
Ibuprofen 400 to 600 mg plus acetaminophen 500 mg as needed for pain every 6 hours