Chemical dependency and substance abuse is a societal and health care problem that presents unique complications for general dentists whether they are treating active drug abusers or recovering addicts and alcoholics who have been sober for years, according to an article in the December issue of AGD Impact, the newsmagazine of the Academy of General Dentistry (AGD).
With an estimated 22 million substance abusers in the United States and prescription medications the second most abused substance after alcohol, it is likely that most general dentists will face this challenge at some point. Substance abuse cuts across all demographics.
With an active addict, dentists are challenged to recognize the telltale signs of a drug-seeking patient; understand the oral health implications of drug abuse; grasp the contraindications between street drugs and the pharmaceuticals commonly used in dental treatment; and be able to clearly and compassionately communicate with the patient regarding risk factors and potential sources of help.
To successfully treat recovering alcoholics and addicts, dentists need to familiarize themselves with the disease process of chemical dependency; take added precautions when prescribing potentially addictive drugs; and understand the potential impact of anesthesia-or even mouthwash-on a patient's sobriety.
Additionally, patients who are abusing drugs or recovering from addiction raise unique liability issues. While cases are rare, patients have been known to accuse dentists of initiating an addiction or relapse, or blame them for complications relating to drug interactions, according to Richard C. Engar, DDS, FAGD, attorney in fact/CEO for Professional Insurance Exchange in Salt Lake City. But with an investment in continuing education and a review of practice management policies, experts say GPs can protect themselves and provide care to patients with substance abuse issues that extends beyond the patients' oral health.
According to Michael Fishman, MD, addiction specialist and program director of adult addiction medicine services at Atlanta's Ridgeview Institute, many dentists, like most people, share a general ignorance of the disease process of chemical dependency. "There is a bias about addiction, a belief that persists that chemical dependency is a moral issue and not a disease," says Dr. Fishman. "The problem is that this bias can be deadly when it is held by health care professionals."
He warns that dentists' and physicians' ignorance of chemical dependency issues endangers patients and leaves GPs vulnerable on various fronts, from being threatened by an aggressive drug-seeking addict to being sued for prescribing a drug that triggers a recovering addict's relapse.