title: Comparison of narcotic prescribing habits and other methods of pain control by oral and maxillofacial surgeons in the United States and Canada.
abstract: OBJECTIVE
  A previous study of the narcotic prescribing habits and other methods of pain control used by American oral and maxillofacial surgeons (OMSs) after the removal of impacted third molars showed that they often prescribe more tablets of a narcotic than may be necessary. It has been suggested that the excess tablets could be diverted for nonmedical use. The purpose of this study was to determine whether Canadian OMSs have similar narcotic prescribing habits, because Canada has the second highest oral consumption of prescription oral narcotics in the world.
  
  
  METHODS
  An 8-question survey similar to the one used in the US study was sent to all active members of the Canadian Society of Oral and Maxillofacial Surgeons; there was a 47% return.
  
  
  RESULTS
  In Canada, the postoperative use of a steroid was slightly greater than in the United States, but the use of a long-lasting local anesthetic was essentially the same. The most frequently prescribed narcotic in the United States was hydrocodone, whereas the most frequently prescribed narcotic in Canada was codeine. However, the concomitant use of a nonsteroidal anti-inflammatory drug (NSAID) with the narcotic was significantly greater in Canada than in the United States. The number of tablets of narcotic prescribed by Canadian OMSs also was larger than in the United States.
  
  
  CONCLUSIONS
  The use of codeine plus an NSAID by Canadian OMSs for managing pain after the removal of impacted third molars rather than the more addictive drug hydrocodone raises the question of whether the latter drug is being overprescribed in the United States.
authors.affiliation: Associate Professor, Northern Ontario School of Medicine, Thunder Bay Campus; Private Practice, Thunder Bay Regional Health Sciences Center, Thunder Bay, ON, Canada.
authors.forename: Bruce R
authors.initials: BR
authors.lastname: Pynn
authors.affiliation: Professor and Chairman Emeritus, Virginia Commonwealth University School of Dentistry, Richmond, VA. Electronic address: dmlaskin@vcu.edu.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Laskin
mesh_terms: D002170:Canada; D017723:Drug Utilization Review; D006801:Humans; D009294:Narcotics / Q000627:therapeutic use*; D019647:Oral Surgical Procedures / Q000009:adverse effects*; D059408:Pain Management / Q000379:methods*; D010149:Postoperative Pain / Q000188:drug therapy*; D013515:Surgery, Oral; D014481:United States
chemical_list: D009294:Narcotics