Drug abuse

Prescribed drugs

The medical history should reveal if the patient takes any prescribed medication (see also General Patient History) and especially whether in the correct dosage. Fear of oral surgery may induce a temporary overconsumption of drugs such as beta-blockers or psychotropics. Among psychotropes, abuse of narcotic analgesics from the opioid group such as the moderately potent pentazocine, tilidine, and tramadol, must be taken seriously. A complicating factor is that some trade names of the very potent morphine and derivatives are not easy to recognize, i.e. Roxanol, Kadian, MS contin, etc.

Anti-depressants and tranquilizers are also psychotropes and have addictive potential. Monoamine oxidase inhibitors and tricyclic antidepressants have many adverse effects and are addictive.

Local anesthesia with (nor)adrenalin can result in acute hypertension in the presence/abuse of MAO inhibitors, tricyclic antidepressants, non specific beta adrenergic blockers, cocaine, phenothiazides. Albuterol in asthma inhalers for example, can increase blood pressure and pulse rate.

Multiple drug intake reveals multiple health issues, all possibly interfering with surgery and/or treatment compliance. A cytochrome P enzyme which is responsible for the biotransformation of one drug can be inhibited by another and thus cause toxicity. The clinician must be careful to consider possible drug interactions and contra-indications as both accumulate as a patient takes more medications.

Nonprescribed / OTC drugs

A first question should be why the patient takes OTC (over the counter) drugs and/or food supplements. Grapefruit for example interferes with the breakdown of statins, the most prescribed anticholesterol medication, leading to its accumulation. Some forms of licorice can result in digoxin toxicity. Ease of purchase of these drugs predisposes to overconsumption and dosage should be recorded. 

Some OTC drugs can interfere with the planned medications and procedures. For example, Aspirin prolongs the bleeding time and food supplements such as gingko interact with blood thinners.

Some OTC drugs like cough syrups can be addictive. They often contain dextromethorphan which, when consumed in large amounts, give the impression of being high.

Drug abuse and implant treatment

When a patient is addicted to drugs, the clinician must consider interactions with planned treatment and medication. In addition, a broader question arises of whether the patient medically, psychologically and socially qualifies for implant-based treatment with its necessary compliance and maintenance care. Referral to an internist or specialist may be indicated for additional medical and psychological advice. In case of doubt, consider non-implant based treatment alternatives until drug abuse has ceased.

Drug abuse influences especially:

• blood pressure
• blood coagulation
• healing processes
• body’s immune reaction
• interactions with treatment-related medication
• social behavior

Medical records

Record all available information about drug/food supplement intake in your patient file.