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MyView: Opioid addiction: Perspective from a father, clinician and educator

January 22, 2018

By Omar Abubaker, D.M.D, Ph.D.

Photo of Dr. Abubaker
Omar Abubaker, D.M.D, Ph.D.
My son's journey to heroin use started with a prescription for hydrocodone after a shoulder injury he sustained in high school. That's all it took to trigger his biological dependence on prescription narcotics, which eventually progressed to heroin. He entered treatment and stayed in recovery for almost a year before relapsing and dying of a heroin overdose. Adam was 21 years old.

Nothing is ever the same after losing a child, and the daily news of similar tragedies across the U.S. are constant reminders of our loss.

As an oral and maxillofacial surgeon, I was trained to treat pain as a fifth vital sign. I felt that I had to treat my patients' pain generously and with the best tools I have, as if the goal was total elimination of pain 100 percent of the time. Prescribing opioids after extracting teeth or performing corrective jaw surgeries became a seamless part of my busy daily practice. And until I lost my son to addiction, I had no reason to question my prescribing habits.

To honor my son's memory, I set on a mission to understand addiction and how my son ended up a casualty, which happened right before my eyes despite my scientific knowledge and clinical experience. I enrolled in and completed an online certificate graduate program on addiction study, where I gained insight on the science of addiction, the current opioid endemic, and its impact on individuals, families and society.

What I learned is that addiction is a chronic relapsing disease, just like diabetes, cancer and heart disease. The American Medical Association, the American Society of Addiction Medicine and even the ADA recognize addiction as a chronic organic disease of the brain tied to a combination of behavioral, environmental and biological factors, with genetics accounting for about half of those. It is not the behavioral weakness, character flaw or moral failing that so many believe.

I also learned that despite encountering the many forms of the disease in my daily practice over the years, I had been ill-prepared to deal with it despite my education as a dentist and my advanced training as an oral and maxillofacial surgeon. I had a shallow understanding of the scientific basis of orofacial pain. I also lacked respect for the addictive potential of prescription narcotics.

My ongoing journey has taught me to be more careful in my prescribing and what I teach my students and residents. I now spend more time discussing postoperative pain management with my patients. When I prescribe opioids, I use the lowest possible dose and follow the rule of thumb "start low and go slow." I'm especially diligent about discussing the possible risks and complications of any medications I prescribe and explain why it's so important to properly monitor, secure and dispose of left over opioids.

I'd like to challenge my fellow dentists, particularly those in my generation, to reexamine their pain management practices, especially when it comes to prescribing narcotics. So much has changed since I was in dental school.

I'd also like to challenge educators to review and revise our current curricula in dentistry to be in pace with current knowledge of addiction and integrate such knowledge with contemporary pharmacology into clinical practice and acute pain management. We are doing just that at the Virginia Commonwealth University School of Dentistry.

We owe it to our patients, our families, our friends, and our communities to be part of the solution to the opioid crisis. I certainly owe it to my son.

Dr. Omar Abubaker chairs the Department of Oral and Maxillofacial Surgery at the Virginia Commonwealth University School of Dentistry.