The Articulate Dentist - A Blog by the Metro Denver Dental Society

Needles, Tongues and Lungs

The Chemistry, Use and Effect of Psychoactive Substances

 By: Ms. Amber Riley, MS, RDH, FAAFS, FIACME

Psychoactive substances legal or not, are ubiquitous in our communities and used by the patients we treat. Use and abuse, of psychoactive compounds, date back thousands of years. America’s history with psychoactive substances is a torrid one, I hope to lessen if not eliminate the stigma, secrecy and shame that still associates itself to learning about drugs. A person’s inexperience compounded with curiosity can make a dangerous drug a deadly one on the first use, and any government’s naivety to expect its constituents to abstain from drug use and abuse is just as dangerous.

As of the time of this writing, forty-six states and the District of Columbia have some form of a medicinal or compassionate cannabis use permission or have decriminalized the possession and use of cannabis; eighteen states and D.C. have full legalized use; and the U.S. House of Representatives has passed a bill to federally decriminalize marijuana across all 50 states, with bi-partisan support, and which now sits in the Senate for a vote. In 1967, 10% of Americans favored marijuana being legal and in 1970 marijuana was functionally made illegal by the development of the Controlled Substances Act. States began legalizing marijuana for medicinal use, with California first in 1996, and Colorado and Washington legalizing all use in 2016. The social tolerance for marijuana now stands at over 90% of Americans being in favor of legalizing marijuana as reported by The Pew Research Center in April 2021. (1)

One of my programs for the 2022 Rocky Mountain Dental Convention (RMDC), Needles, Lungs & Tongues, will bring actionable insights to participants who have an interest, in any depth, in the subject of drugs, more specifically drugs that are currently and historically misused and abused. We will review what are many of the most important points of use that we must understand in order to mitigate acute risks when treating patients and what long-term risks will become inherent.

This program should be immediately useful and relevant to dental professionals and drug prescribers. We will move through categorizations, relevant legal authorizations, and considerations for multiple common, and frequently encountered substances of use and abuse that circulate within all of our communities, patient populations, and even in our families. This discussion will meet and exceed the American Dental Association’s published recommendations for continuing education pertaining to opiate prescribing that is specific to dental practice, including alternatives for dental pain management that are scientifically supported by peer-reviewed, replicated research and reliable data from which we may develop safe prescribing policies of schedule II medications all the way up to over the counter choices, and provide the most appropriate care and education of prescribing practices to our patients. Discretionary reporting, intervention and diversion for dental professionals practicing under the influences of psychoactive substances is also addressed.

Is this a complicated and provocative topic? Yes.

Is this topic one rife with political arguments and special interest lobbyists and pharmaceutical billions in play? Yes.

Is this topic one that reaches into every neighborhood and zip code regardless of wealth and privilege or poverty and disfranchisement? Yes.

The mercy of drugs and menace of pain is a great equalizer to the human animal. No one is exempt from the dangers, benefits and vulnerability to any of these molecules. Anyone that has ever taken (or listened to thanks to COVID!) any of my programs can be assured that we will take on this complex topic of substance use and abuse from the same playbook, and we will not dance around any elephants in the room or speak in the boring generalities that dominate the educational coffers in this area of continued education. We will address this subject matter in a straightforward, at times humorous and at times very blunt way. With a friendly approach, we each effectively can meet the needs of our communities that are struggling to stop the tiptoeing that still goes on around these discussions and the reticent lack of acknowledgment of what is harming all of us in one way or another. Reticence results only in a failure to be proactive and to reduce harm.

This program delivers current data, published understanding and facts about what is real, and what is a myth. We draw from the wealth of research that is available from legitimate, respected institutions of higher learning in the United States and abroad, from city to federal law enforcement expertise and from my personal, family and patient experiences. In short, if you are one to clutch your pearls easily, this program is not for you. But if you are someone who finds yourself empowered and more confident when you choose to face uncomfortable topics that you deem important; you are someone who is looking for a program to fulfill mandates on opiate education or you or someone you love is being affected by substance misuse or abuse and you are able to acknowledge the behavior is causing harm, then this program is for you!


Ms. Amber Riley is a dental hygienist in San Diego, CA and a Forensic Dental Consultant for the San Diego County Office of the Medical Examiner. She is also a Forensic Dental Unit member of DMORT/NDMS and serves as an RDH Advisory Board Member to the Oral Cancer Foundation. She is speaking at the 2022 RMDC on Friday, January 22, 2022.