Your next patient may be under the influence of a substance you've never heard of, and it will not show up on a standard drug test.
That is the sobering reality clinical educator Tom Viola, RPh, brings to episode 430 of the Dental Assistant Nation podcast. In this follow-up to our widely discussed episode on cannabis and dental patients, Viola delves deeper into a class of substances he calls novel opioids: drugs that are increasingly available, largely undetected, and potentially life-threatening in a dental setting if the clinical team does not know how to ask about them.
Viola walks viewers through three substances dental practices need to know about.
The first is tianeptine -- colloquially known as "gas station heroin" -- an antidepressant that, in large doses, produces an opioidlike effect but which does not register as an opioid on a standard urinalysis.
The second is nitazines, synthetic opioids developed in Europe in the 1960s that were never marketed because of their extreme addiction potential and which are now appearing on American streets. Like tianeptine, niatazines typically do not show up on routine drug screens because labs are not testing for them.
The third is kratom, a rainforest plant from Southeast Asia whose leaves contain alkaloids that produce both opioid and stimulant effects. Because of that dual effect, patients using kratom do not look like someone under the influence of an opioid. They appear alert and normal, making it especially difficult to identify whether they are impaired -- without directly asking them.
And that is precisely Viola's central message for dentists and dental assistants: You have to ask. Not confrontationally, not judgmentally, but clearly. The script he recommends is simple -- "I need to know everything you're taking, because whatever you're using could interact with what we're going to use today, and I don't want anything to harm you" -- and then pausing for the patient to respond.
Viola is equally direct about documentation. Whatever the patient says, yes or no, goes in the chart. Because if a patient goes into deeper sedation than expected or an airway becomes compromised, the first question in any subsequent litigation will be, "Did you ask?"
Dental assistants, Viola reminds us, are often the person a patient trusts the most. That trust is a clinical asset, and knowing how to use it could save a life.
To learn more, visit TomViola.com or find him on Instagram at @ThomasViolaRPH.
