Prof. Ken Hargreaves, Chairman of the Department of Endodontics at the University of Texas Health Science Center in San Antonio, claims that opioids are "powerful analgesics" for dentistry.  He does say that they have significant side effects, but he still approves of them for severe pain despite extensive research documenting that they are grossly inferior to non-narcotics for severe dental pain. Drugs for pain management in dentistry. Hargreaves K, Abbott PV. Aust Dent J. 2005 Dec;50(4 Suppl 2):S14-22. E-Mail: hargreaves@uthscsa.edu Phone: (210) 567-3381. 

Email sent 1/21/06: Dear Dr. Hargreaves: I was very troubled by your claim in the Australian Dental Journal, December, 2005, that opiates are "powerful analgesics" for dental pain. It appears that you approve of their use for severe dental pain.  

    I am a psychiatrist and not a dentist. I have recently gathered 31 double-blind studies comparing various non-narcotic pain relievers to narcotics for the pain following dental surgery. In 26 of 31 studies, the narcotics were inferior pain relievers to the non-narcotics and only equal in the other five. In three of those other five, the narcotics had higher rates of side-effects. Thus, in only two of 31 studies did narcotics even come out even.
    I would like to know the evidence you have for your claim that narcotics are powerful pain relievers. Do you have even one single controlled study where a narcotic was superior to non-narcotics for dental pain?
    It would appear to me simply unethical and malpractice for dentists to be giving narcotics to patients for dental pain. In just the last four months I have had two patients started on narcotics by a dentist prescription of a narcotic. Both ended up heroin addicts after several months of narcotic pain pills, despite only being cigarette smokers with infrequent marijuana usage prior to the prescription. A third woman had just achieved 2 years of abstinence from heroin, when her dentist gave her a prescription for Vicodin following surgery. He never bothered to ask if the women had any history of substance abuse. Wouldn't you consider that malpractice?
    Please send me the evidence for your claim or tell me that you have no evidence.
Thomas E. Radecki, M.D., J.D., Research Director, Doctors and Lawyers for a Drug Free Youth.

Professor Hargreaves replied saying that I had misunderstood him.  He offered no research to support his claims.

Thomas E. Radecki, M.D., J.D.

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