THE PARALLEL PANDEMIC FOR HISPANICS Edwin A. Del Valle-Sepulveda DMD, FAAOMS, JD Aisha K. Ba, DMD San Juan, Puerto Rico Abstract While being faced with the Covid-19 pandemic, our society has been enduring a more silent and longerlasting epidemic behind the scenes. According to the Center for Disease Control and Prevention, drug overdose in America has been responsible for over a half-million deaths in the last decade. Addiction and abuse of alcohol/and or drugs, also known as substance use disorder (SUD), does not distinguish between age, gender, sexual preference, or ethnicity. The Hispanic community has unfortunately not gone untouched by this silent social menace. The reality is that research and awareness are lacking in this community to evidence the realities of an ongoing crisis. To help mitigate the situation, the dental team must be aware of the signs, symptoms, and resources available to help eradicate this plague that is taking so many lives. Key Words: Opioid, Covid-19, Pandemic, Hispanics, Overdose, SUD, Substance Use Disorder Introduction Dentistry is no stranger to discomfort and pain due to the nature of the structures and tissues worked on. As oral surgeons and dentists, we value the management and understanding of pain as a priority. Pain in the oral cavity results from a combination of factors: infection, trauma, disability, and psychological components that play roles in nociception. Great awareness has taken place in the component of pain management found in oral health care. Furthermore, understanding the risks of prescribing controlled substances has made great strides in the dental profession since the Centers for Disease Control and Prevention (CDC) began reporting the opioid epidemic in 1999. The liberal administration and prescription of synthetic opioids by medicine and dentistry are now accepted as contributors to this crisis. Recently, settlements by pharmaceutical companies for billions of dollars for reparations have also made the news. Despite
changes in the health professions, pain management through the prescribing of opioids is part of the patient pain management armamentarium. Improvements have been made through precautionary measures such as prescription monitoring, improved mandatory provider education, and patient education. Having the safeguards and control measures in place would seem to result in a reduction in prescription drug abuse (addiction or dependence), illicit drug use, and substance use disorder (SUD). Unfortunately, the wildfire of addiction and access to synthetic opioids rages on in our society presently. Most recently, the CDC released data in November of 2021 showing that the opioid epidemic has not shown signs of slowing down. Rather, an alarming increase has taken place now with over 100,000 drug overdose deaths a year, from May 2020 to April 2021.1 This represents an increase of almost 30% from the previous year has taken place.1 Compounding the tragedy, this period runs parallel to the established Covid-19 pandemic that is associated with contributing to the problem. The Covid-19 crisis is known to have created worries from perceived health, employment, and social uncertainties. 2021 as a year was very deadly in that overdose (OD) death outpaced homicide during January by a four to one comparison which means overdose death exceeded homicides by over 300%. When we look at deaths by suicide and motor vehicle accidents, together they are still only 84.5% of death attributable to overdose in America.2 The data shows that men aged 25-34 are the most vulnerable demographic to death by OD while women ages 45-54 are the most affected by death from OD.2 The groundbreaking report by the Substance Abuse and Mental Health Services Administration (S.A.M.H.S.A.) in 2020, The Opioid Crisis and the Hispanic/Latino Population: An Urgent Issue, reported that Hispanics have a unique battle in the Opioid Crisis. For 2018, 1.7 million Hispanics aged 12 or older are estimated to have engaged in opioid misuse.3 Hispanics in high school in 2017 had the highest percentage of prescription opioid misuse (15.1%) as compared to peers of other ethnicities.3 Of concern, Hispanic eighth-graders had the highest rates of substance misuse for all substances compared to Whites and African American peers.3 From 2014 to 2017 an increase in synthetic opioid
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