Drug abuse. Its relationship to dental practice.

Drug abuse appears destined to become an exacerbating cultural phenomenon despite intrinsic dangers to the abuser and accelerating costs to society. Dentists cannot afford to ignore the problem or its sequelae either in terms of their personal involvement or in terms of the clinical implications of such a practice for their patients. Abuse of agents, such as opioids and amphetamines, by the dental practitioner leads to devastating personal, social, and professional consequences. The abuser jeopardizes his or her reputation, family relationships, professional practice, and, not uncommonly, his or her very life through accidental overdose of drugs or by suicide. Nitrous oxide abuse is particularly prevalent among dentists and, although producing no psychological dependence, may result in long-term myeloneuropathy and physical disability making continued dental practice impossible. The dentist's responsibilities in this area lie within clinical and social domains. Clinically, the dentist must (1) learn to detect those physical and behavioral signs in patients that are indicators of drug abuse; (2) become familiar with tactics employed by drug abusers to obtain drugs for themselves or for further criminal diversion, and be prepared to defend against such tactics; (3) understand and make clinical allowance for therapeutic complications that may arise in the treatment of drug-abuse patients. The dentist's social role as an informed, concerned, and empathic counselor in matters of drug abuse must be assumed as a personal imperative and not viewed as an intellectual abstraction. Whenever we are made aware of the drug-related devastation or death of a friend, colleague, or student, we discern the immediacy of an ethical responsibility of social dimensions, so eloquently expressed over 350 years ago, by John Donne in his "Devotions XVII": "No man is an island, ... Any man's death diminishes me, because I am involved in Mankind; And therefore never send to know for whom the bell tolls; It tolls for thee".