The most significant source of prescription opioids in 2022 was tooth extraction, where 8,910,437 opioid prescriptions were written by dentists. This led to 5 million opioid-naïve young people receiving opioid analgesics annually following the extraction of third molars. Each unused tablet, potentially diverted for another indication endangered patients because it may cause an addiction. Those adults, who initially received an opioid prescription were much more likely to misuse prescription opioids.
The surge in opioid-misuser deaths in addiction passes through becoming an addict following their first misuse. The findings of the Opioid Analgesic Reduction Study support the use of a combination of ibuprofen and acetaminophen as the preferred analgesic for managing acute pain following impacted third-molar extraction surgery.
The Rutgers University Institutional Review Board was the designated single institutional review board for protocol 2020002299. Written consent was obtained from all participants to authorize their participation in the study. The record study was registered on ClinicalTrials.gov on April 7, 2020, and published on June 30, the same year.
The first patient consented to participate and was randomized on January 7th, 2021. The Director of the National Institute of Dental and Craniofacial Research, National Institutes of Health, set up a Data and Safety Monitoring Board and appointed a clinical monitoring organization to supervise the trial. Data-sharing details are available in eBox, located at the end of the referenced manuscript, and accessible electronically.
A multicenter, randomized, double-blind, stratified noninferiority trial was conducted to determine whether combination nonopioid analgesics are as effective as opioid analgesics. The study evaluated patient-centered outcomes following impacted mandibular third-molar extraction surgery. The patients were enrolled and provided with 5mg hydrocodone and 300mg acetaminophen mixture (Opioid) or 400mg ibuprofen + 500mg acetaminophen soft gel (Nonopioid). Post initial dose, the analgesic was taken every four to six hours if needed to alleviate pain.
In this randomized multisite clinical trial (n = 1,815 adults), in which participants did not take opioids, pain for the first day and night as measured on a numeric rating scale ranging from 0 to 10 was lesser (the mean difference, –0.70; 95% CI, –0.94 to –0.45; P < 0.001) than those who did as well as pain suffered during second day night (the mean difference, –0.28; 95% CI, –0.52 to –0.04; P = 0.015) average difference between the two groups for the whole postoperative period was no different than those who consumed opioid (the average difference, -0.20; CI 98.75%, -0.45 to -0.05; P = 0.172). For the success of the visit, patients without opiates tended to be more satisfied following the procedure (postoperative satisfaction of 85.3% against 78.9% of participants who used opioids even after their withdrawal with a 95% CI of 1.21 to 1.98; P = 0.006).
Concisely stated, addiction or substance abuse at the personal or familial level was cause for the exclusion of any participants in the study and its generalizability as well. The aim of the study cited above was the undue decoupling of opioids and the non-opioid combination. Administration of local anesthetics on a long-standing basis would have an undesired effect on a treatment response. The non-prescribed, atypical dosing schedules employed may have some role in skewing the number of pills consumed, but this raises the need for a more thorough investigation of the nature and extent of the treatment response, which is not the goal of this report. Adjusting to fixed intervals of taking the medication would have improved the nature of the findings but taking the medication when feeling like it was employed to prevent the possibility of addiction in the future. To avoid the above situation, we ensured that all subjects kept diaries, recording pain and medication use three times per day at predetermined intervals.
The inappropriate use of opioids in the management of postsurgical pain fuels the opioid crisis that kills some 81,000 people annually. Developing effective nonopioid analgesics is essential to reduce the growing numbers of opioid-related addictions and deaths. Patient demand for opioids and surgeons’ prescriptions are shaped by the misconception that opioid analgesics are better than their nonopioid alternatives. However, numerous studies demonstrate the efficacy of nonopioid options for pain management.
Reference: Feldman CA, Fredericks-Younger J, Desjardins PJ, et al. Nonopioid vs opioid analgesics after impacted third-molar extractions: The Opioid Analgesic Reduction Study randomized clinical trial. J Am Dent Assoc. 2025 Jan 4:S0002-8177(24)00639-1. doi:10.1016/j.adaj.2024.10.014
