The wisdom of saying "No" to Norco and other opioids for your teen

My children got teeth at 3 months, putting them on the earlier side of the teenage rite-of-passage of wisdom teeth removal. My son's younger age (15) and the logistics of scheduling - after summer school, but before vacation and football tryouts - were top of mind in the oral surgeon’s office. That morning I was “pragmatic-we’ve-already-lived-through-this-once-let’s-get-it-over-with-working-mom.” Before I knew it, the surgery was scheduled, and we were out the door with pre and post-op instructions and prescriptions (handed to me by the front desk) to fill prior to surgery. 

Later, as I sorted through the paperwork, I caught myself staring at 3 prescriptions. How was it that I gave more thought to the family calendar than to discussing pain relief with the surgeon? I considered myself well-versed on the opioid epidemic and initiatives to limit the number of pills in the ecosystem to curb abuse. I incorrectly assumed that as a result of increased public awareness of the opioid crisis that the surgeon had changed her prescribing practice since my daughter’s procedure 2 years prior. I wasn’t feeling like much of an industry “expert” at that moment.

She’d prescribed an antibiotic, 800 mg Ibuprofen (the equivalent of 4 Advil) and Norco, an opioid blend of Hydrocodone and acetaminophen. I did some quick research. This graphic with the word “heroin” shifted me into a different “mom-mode.”

Gary Mendell is the Founder and CEO of Shatterproof. It’s a nonprofit organization dedicated to ending the devastation addiction causes families, as it had done to his. He has this to say about our work as parents.

“Like Brian [his son], the majority of those addicted—nearly 9 out of 10—began experimenting with substances before their 18th birthdays, while their brains were still developing. We as a society are not protecting our children when they are most vulnerable to becoming addicted and unable to protect themselves.” 

Let that sink in for a moment. We’re vigilant about reducing sugar and providing organic free-range antibiotic-free poultry while exposing our teens to addictive prescription medications because it’s what the “doctor ordered.”

I called the surgeon’s office and explained to her staff that I didn’t want him taking an opioid and was interested in alternatives. There was silence followed by a statement that he didn’t have to take it; it was to have at home “just in case.”

I could have chosen not to fill the Norco, but I returned to the surgeon’s office and exchanged the script for an alternative. Completely missing the point of my concern, they’d replaced the Norco with Tylenol and Codeine, which is also an opioid.

Sigh. 

When I met with the pharmacist and discussed this process, she commented that there was a strong reluctance to modify habits.

“The oral surgeons won’t change what they prescribe before surgery" the pharmacist explained. "Trust your instincts as a mom.”

That’s alarming commentary given the significant role physicians play within this complex issue. The American Dental Association has revised their guidelines for opioid prescribing. Their FAQ encourages dentists not to automatically include opioids as a first-line therapy for pain. A good step in the right direction.

While only 11 percent of all opioid prescriptions annually are generated by dentists in UnitedHealthcare’s commercial business, 47 percent of the opioid prescriptions for teens (ages 15-19) are prescribed by dentists. These are most commonly associated with wisdom teeth extractions.

I wish I’d been proactive from the beginning like this strong mom who ripped up the prescription for her teen. I love that visual. In my defense, she's a Shatterproof employee.

Following successful surgery, he iced and only needed the prescribed Ibuprofen for 3 days followed by a few regular Advil day 4. It was back to shooting hoops and Fortnite for him, but this personal experience got me thinking about what I can do to help. I'm starting with sharing this story.  

Industry Action

Cigna, an industry leader on this issue and early Shatterproof partner, achieved a 25% reductionin opioid use amongst their commercial customers over the past 2 years. UnitedHealth Group is sponsoring Shatterproof’s new Family Program and other companies contribute content and grants to fund their evidence-based website.

Insurance companies and pharmacy vendors can’t bear all of the responsibility of opioid/pain management education; we can’t rely on doctors to readily change their habits. I’m interested in exploring how dental insurance carriers, concierge customer service platforms and employee benefits brokers and consultants can incorporate adolescent wellness & prevention messages into their interactions with employees of the clients they serve.

A call to action. Get involved and educate family, friends, and customers.

• Avoid taking opioids. If you’re unclear what’s been prescribed or is in your medicine cabinet, check here with Cigna's tool. It's what I used to research the first prescription we received.
• Don’t automatically fill a prescription because it’s handed to you. Ask about your options. Disclose if there is family sensitivity to having opioids in your home. Use this checklist to guide the discussion.
• When prescribed, start with the lowest dose for the shortest time possible. Everyone’s tolerance for pain is different.
• Never take medication prescribed for someone else.
• Just because pain medication was prescribed doesn’t mean you have to take it. Dispose of any unused medication. Don’t save them “just in case.”

Industry peers - 3 ways to enhance your knowledge

• Leverage these employer resources
• Use the National Safety Council and Shatterproof’s Calculator to estimate the real costs of substance use in your workforce.
• Register for Optum and Shatterproof’s August 16th video event that will outline a comprehensive approach to prevention, treatment, and support. All are welcome - employers, brokers & consultants and payers. 

Closing thought

It's a challenge to practice at home what we preach in our professional lives. Sometimes these industry observations are inspired in the parenting trenches, as I opined here about documents requiring my 18-year-old’s signature.  Let's continue the dialogue here or contact me directly at [email protected].