Is it Time to Relegate Routine Opioid Prescriptions to the Oral Surgery Archives?

Abstract

The end of the 1970s ushered in what became an accepted standard of care for most of medicine and dentistry, including oral and maxillofacial surgery: Hydrocodone with acetaminophen was introduced as Vicodin (Knoll Pharmaceutical, Whippany, NJ) in 1978 and rapidly embraced by providers to treat all types of pain. Curiously, centuries-old concerns about opioid addiction were largely set aside, and hydrocodone-acetaminophen combinations became the most-prescribed drugs in the United States by the early 2000s and remain in the top 10. However, it was aggressive and effective marketing by Big Pharma and other external forces, instead of valid supporting data, that prompted the routine prescription of opioids for acute pain. 1 Chidgey B.A. McGinigle K.L. McNaull P.P. When a vital sign leads a country astray—The opioid epidemic [published online August 14, 2019]. JAMA Surg. doi:10.1001/jamasurg.2019.2104 Google Scholar Hydrocodone-acetaminophen became the gold standard for pain management after oral surgical procedures despite no references in the literature showing opioids were more effective than nonsteroidal anti-inflammatory drugs (NSAIDs), as well as failure of pharmaceutical manufacturers to substantiate marketing claims of the nonaddictive nature of their new opioid formulations.