THERE is hardly a day without the daily newspaper carrying an article about someone being accused or convicted of either trafficking or using cocaine or marijuana. In fact, Guyana can be considered apocalyptic in this regard.

While drug-abusing patients may be difficult to identify, an alert dentist can contribute significantly towards mitigating the problem. The following are general physical or behavioural signs that should alert the dentist to suspect that they are dealing with an addict.

1. Inability to spit normally
2. Changes in normal work habits, attendance or efficiency
3. Deteriorated physical appearance and personal hygiene
4. Efforts to cover up arms and wrists to hide needle marks (use of intravenous drugs results in discoloured skin)
5. Wearing sunglasses at inappropriate times; addicts may be hiding constricted or dilated pupils or bloodshot eyes
6. The presence of poorly defined and low-grade fever. The narcotic addict, in particular, may approach the dentist posing as a legitimate patient to obtain opioid substances. The abuser may attempt to obtain paregoric, from which he can extract opium, by claiming to have a child who is restless and in pain because of cutting teeth.

An addict may fake pulpitis (toothache) or present with an oral abscess, requesting narcotics to temporarily relieve pain. He will usually claim an allergy to weaker agents such as codeine or propoxyphene and helpfully suggest that Meperidine or Percodan has worked well in the past. Narcotic abusers also seek morphine and hydromorphone.

A dentist who accommodates a drug abuser by writing prescriptions for large amounts of drugs runs a real risk. Having once committed such a criminal act, the practitioner may be blackmailed under the threat of exposure, mutilation or death into becoming a perpetual drug supplier for the abuser, his friends or the underworld syndicate.

Drugs of abuse are divided into three groups, central nervous system depressants such as morphine, alcohol, diazepam and nitrous dioxide; CNS stimulants such as cocaine and amphetamine; and hallucinogens such as marijuana and LSD.

It may surprise many to learn that of the nine basic substances classified as drugs of abuse, morphine is by far the worst while marijuana is relatively harmless from a chemical standpoint. In fact, marijuana does not present tolerance or psychological dependence and only mild physical dependence. On the other hand, morphine exhibits psychological dependence as well as tolerance.

Abuse of cocaine ranks second only to morphine. These drugs wreak havoc with the social fabric of society. The dentist’s role as an informed, concerned and empathic counsellor in matters of drug abuse, apart from the other relevant professionals, 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, we discern the immediacy of ethical responsibility of social dimensions.

The poet John Donne wrote 370 years ago: “No man is an island…Any man’s death diminishes me, because I am involved in mankind, and therefore never sends to know for whom the bell tolls; it tolls for thee.”