Teens get addicted to opioids after wisdom teeth removal. Insurers are cracking down

Kansas City Star (MO)

March 04-- Mar. 4--Rock bottom for Anna came during one of her stints detoxing from opioids.

"My dad lay next to my bed while I just shivered," she said. "I was like 110 pounds. Just not a good life at all. It's a pretty dark place."

Anna (The Star isn't using her last name to protect her privacy) is now a 27-year-old Kansas City mom, clean for seven years. But at 17, she went to the dentist to have her wisdom teeth removed. That routine rite of passage led her down the path to dependence on pain pills and, eventually, to shooting heroin.

A recent study validated what insurance companies have suspected for years: Painkiller prescriptions for teens and young adults following routine dental care contribute significantly to the national opioid addiction and abuse epidemic. Several insurers announced recently they are now limiting coverage of opioids after dental work.

The study, published in JAMA Internal Medicine in December, looked at people age 16 to 25 who first used opioids after dental care. They were more than 10 times more likely than their peers to be diagnosed with opioid abuse within a year of getting that prescription.

Ted Wong, the chief dental officer for UnitedHealthcare, said it makes sense. Adolescents are more prone to drug addiction than adults because their brains are still developing, and wisdom tooth removal is a common surgery for that age group. About 5 million Americans have it done every year, and most of them are adolescents or young adults.

"That gave us a reason to kind of look at that high-risk population," Wong said.

Anna said that when she had her wisdom teeth removed, no one, including her parents' insurance company, questioned the amount of painkillers she was given.

After the initial surgery, she said, her dentist sent her home with about 10 days' worth of Vicodin. After that ran out she was still in pain, so she went back and the dentist discovered a small shard of one tooth still lodged in her gums.

He removed that, then wrote her a prescription for more pain pills. By the time that ran out she had been on them for about three weeks and was craving them. It didn't take long to find other kids who had access to them -- either their own prescriptions or those of family members.

"I started buying pills from other people," Anna said. "In 2010 it was very easy to get ahold of any opioid-based pain pill. They were expensive, but they were available."

Later that year Oxycontin, one of the most popular opioid pills on the market, was reformulated to make it harder to break down and abuse by injecting, snorting, chewing or smoking.

So Anna turned to heroin, which was cheaper.

"That's when I really quit (opioids) was when I got into heroin," Anna said. "It took me out really fast and I was just like, 'I can't do this any more.'"

Minnesota-based UnitedHealthcare found that about 70 percent of its customers got an opioid prescription after having their wisdom teeth removed, and nearly 45 percent of all opioid prescriptions written to adolescents came from dentists.

Like other insurance companies, it is increasingly armed with terabytes of health data, and, Wong said, has been analyzing that data for years to find out what's driving the opioid epidemic.

In early February, the company announced it was making several changes to its coverage for dental opioids, changes Wong said were in the works even before the JAMA study was published.

They include limiting first-time prescriptions for teenagers to no more than three days' worth of pills and capping the dosage to follow Centers for Disease Control recommendations.

Wong said the company is also working to educate dentists about alternatives to opioids, including a combination of Tylenol and Advil.

"Recent studies have shown that (combination) to be as effective, if not more effective, than opioids in managing dental pain without the risk of addiction," Wong said.

Cigna has limited its opioids coverage to no more than seven days' supply.

"Dental professionals have a front-line opportunity to fight back against the opioid epidemic and improve the coordination and quality of care for patients," Michael Hahn, Cigna's national dental director, said in a statement released by the company this week. "Most dental pain can be managed through non-opioid alternatives, but in circumstances where a dentist believes an opioid is the best option for relieving dental-related pain, we encourage proceeding with caution and prescribing the lowest dose and quantity possible."

In 2017, Aetna began sending letters to dental "super-prescribers" who routinely wrote more than a seven-day supply of opioids for their patients, notifying them that they were outliers among their peers.

The American Dental Association has also tried to raise awareness of the problem among its members, publishing guidelines in 2016 and 2018 that encouraged them to limit opioid prescriptions and tell their patients how to properly dispose of unused painkillers so the drugs don't end up being abused by others.

Google announced earlier in February that its Maps application would begin including sites to drop off unused drugs whenever users search for things like "drug drop off near me" or "medication disposal near me."

Anna said they're all welcome changes that might have helped her avoid years of heartache.

Getting off opioids, she said, was "the worst and best experience of my whole life." She did it through drug treatment counseling, a medication called Suboxone and a daily jogging regimen.

She's now seven years off opioids and almost five years off all other drugs, with a partner, a house, a job and a young son. But it was a long journey to get there, and she's keenly aware that it's not over. She declined all painkillers when she was in labor, because she feared a relapse.

"My life is as normal as most people's I think, (but) I never thought I'd get here," Anna said. "I spent a lot of time in jail because of my addiction and it really just started with pain pills. I just got sucked in and I had no idea."

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