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Two recent articles have again highlighted how often opioid pain relievers — medications like oxycodone and hydrocodone — are excessively prescribed in the U.S. for acute pain, sometimes for vulnerable populations, and sometimes for conditions for which they are probably not even indicated.

The first paper, by authors at Boston Children’s Hospital, evaluated visits to the emergency department by adolescents and young adults (ages 13 to 22) over an 11-year period from a nationwide sample.

About 15% of patients — roughly one in six — were prescribed an opioid, with high rates seen for ankle sprains, hand fractures, collarbone fractures and dental issues, for which an incredibly high 60% of patients in this age group received an opioid.

The second paper compared opioid prescribing by dentists in the U.S. and England in 2016, and the numbers are shocking. U.S. dentists prescribed about 35 opioids per 1,000 people, compared to just 0.5 opioid prescriptions per 1,000 people in England.

The pain experienced by people in the U.S. can’t be staggeringly different than in the U.K. So why the discrepancy?

In the U.S., prescribers were reassured for years that opioids were a safe and effective way to treat pain. Yes, they are effective. But as evidenced by the vast increase in opioid-related overdose deaths seen in the country over the past decade, they are not safe.

OTC pain meds work, too

On the other hand, medications like acetaminophen and ibuprofen — over-the-counter pain medicines that you can get at any supermarket — actually work amazingly well for acute pain.

As an example, a large survey study of more than 2,000 patients who underwent a range of dental procedures discovered that the vast majority experienced adequate pain relief with over-the-counter or non-opioid prescribed pain medications.

Similar studies are abundant. Another looked at patients treated for low back pain in the emergency department and found no difference in pain after five days, whether the patient was treated with an anti-inflammatory medicine (naproxen) or an opioid. It just didn’t make a difference, so why take the risk?

When an opioid makes sense

Of course, there are times when the over-the-counter medications are not going to be sufficient to treat acute pain. In those situations, the goal should be to take non-prescription medications first, and then add an opioid only when the pain is unbearable.

Typically, this period of severe pain is in the first three days after a surgery or trauma. For example, my colleagues evaluated opioid consumption in the days after suffering an acute fracture. Most patients needed only about six oxycodone pills.

We therefore subscribe to the recommendations of the Opioid Prescribing Engagement Network (OPEN) program in Michigan, which recommends relatively small opioid prescriptions after surgery, such as 10 pills after having your appendix removed or hernia repaired, and just five for procedures like a breast biopsy.

Patients do fine with these smaller numbers of pills, and they’re at less risk of developing long-term opioid use.

How to discard leftover pills

When the acute pain is gone, if there are leftover opioid pills, discard them safely.

Although opioid misuse among teens is decreasing, it still is a major problem. About two-thirds of adolescents who misused opioids got them from friends or family for free.

These medications should ideally be stored securely and dispensed by a parent or guardian following the appropriately prescribed schedule.

There are lots of places to safely discard pills. In fact, the Drug Enforcement Administration has a website that lists the closest bin locations.

If one of those is not accessible, mix the medication with coffee grounds, kitty litter or dirt, seal it in a plastic bag, and put it in the trash. Don’t flush it down the toilet, as opioids and other drugs can contaminate the water supply.

Use minimally, if at all

My general recommendation for opioid-naïve patients, regardless of age, is this: If you have a simple problem, like a sprain or a dental procedure, or even back pain, do whatever you can to avoid an opioid.

Ask your doctor about which over-the-counter pain treatments you can safely take, and maximize those.

For more severe pain, such as from fractures or after surgery, use the minimum number of opioids needed to tolerate the pain, then back off once the pain is bearable. Then continue with non-prescription treatments.

Scott Weiner, M.D., is a contributor to Harvard Health Publications.

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