A DOCS Education Member asks:
I have a 32 year-old male patient with no health concerns other than a past history of opiate abuse. I first saw this patient three years ago for a sedation consultation; he never followed through with further treatment. At that time the patient was taking 24mg of Suboxone® a day. Patient is now down to 1mg of Suboxone® per day and is seeking treatment for his many dental problems. Is this a safe patient to treat with OCS medications, or are there changes I should make to the protocol? Patient may need several root canals and I normally do the extra strength Acetaminophen/Ibuprofen combo for the first day. I do not typically have to call in any pain meds for day two or beyond, but if this patient requires them, what would you suggest I do? My thought is to have the MD managing his Suboxone® make this judgment.
Dr. Jerome Wellbrock, Live Patient Experience Director at DOCS Education, responds:
This patient is a much better candidate for IV sedation over OCS. He obviously has a significant history of long-term opiate use as well as long-term treatment with Suboxone®. He most likely has a significant tolerance and therefore is likely to be a hypo-responder. Suboxone® is a “D” interaction with all our sedation meds and we would want to be able to titrate him to an adequate level of conscious sedation with the least amount of sedation meds possible. As for the use of analgesics in this patient, I would stick with the use of non-narcotic medications. I believe you can adequately manage any post-op pain with NSAIDS.
