Case 2

Initial Presentation: A 37-year-old female presents with a history of orthognathic surgery, temporomandibular joint pain, and high esthetic concerns regarding her anterior teeth. During consultation, she states that she “always needs something strong for pain” and that she cannot take hydrocodone, but has found that oxycodone has worked for previous dental appointments for crowns and veneers. Her PDMP query demonstrates 143 prescriptions within the past year, of which 92 were opioids, 27 benzodiazepines, and 24 anxiolytics. These prescriptions had been written by 42 prescribers, including 8 dentists and she had them filled at 23 pharmacies throughout the metropolitan area.

Action Plan: Inform patient of your findings and discuss your concerns about substance abuse as identified by overlapping prescriptions, request of specific medication, and the potential for doctor shopping (which implies a patient is going from one physician or dentist’s office to another to acquire multiple prescriptions for controlled substances to treat the same symptom).^88,104 Offer to refer patient to a confidential drug treatment expert for evaluation and treatment in conjunction and consultation with her primary care physician.

Conclusion: Patient revealed during the discussion that she had a history of substance abuse disorder and was experiencing a recurrence. She received a referral for assessment and was eventually admitted for in-patient care.