The good news is that Angela Rake’s brother is a cancer survivor.
The bad news is that he came out of cancer care addicted to opioids and — the last Rake heard — was living on the streets in Seattle and using heroin.
“I’m a sister who is grieving the loss of a brother who is still alive,” said Rake, an Eagan-based oral surgeon and adjunct professor at the University of Minnesota School of Dentistry.
Watching her brother’s spiral has moved Rake to speak to her profession regarding the overuse of opioid painkillers, which have been heavily prescribed by doctors — and dentists — in recent years.
Dentists prescribe roughly 12 percent of all opioids for immediate pain relief. They were caught up in the same movement two decades ago to consider pain as the “fifth vital sign” that medical professionals should address in patient care. “The numbers are big,” Rake said.
The topic even came up at a state summit on opioid overuse in August 2015, when Gov. Mark Dayton recalled how, as a recovering alcoholic, he once received a 30-day supply of pain pills after a minor dental procedure.
But Rake said the contribution of dentists to the national opioid epidemic — borne of overreliance on painkillers such as oxycodone to manage pain after surgeries and injuries — has been overlooked.
She said it is equally important for dentists to use alternative forms of pain management; a study last month found that common over-the counter pain relievers beat opioids in managing pain after dental procedures, anyway. She also applauded the American Dental Association for recommending opioid prescribing as a mandatory continuing education topic.
New state opioid prescribing guidelines do include dental procedures. They recommend an initial prescription for acute pain after dental procedures of no more than 100 morphine milligram equivalents. That’s roughly a four-day supply.
Rake said her brother’s route to addiction was unusual. Opioids are recommended to alleviate pain in severe and terminal cancer cases, but he received them after a surgery related to a complication of his cancer care. “We have to keep in mind,” she said, “that physical dependency to opioids can occur, it’s been reported, in as little as five days.”