A 29-year-old presents with pain in the lower left region that did not respond to acetaminophen. You notice needle track marks on his arm. You would do all of the following EXCEPT:

Correct answer: C. Refuse to treat the patient and dismiss him from the practice

• A. Non-opioid analgesia is the right pharmacologic choice. The combination of IBUPROFEN 400-600 mg with ACETAMINOPHEN 500-1000 mg is more effective than most opioid combinations for acute dental pain, with a far better safety profile and no abuse potential.
• B. This is what SHOULD be done, and it is the single most effective analgesic intervention available: identify the cause and treat it definitively. Extirpating an inflamed pulp, incising and draining an abscess, or extracting the offending tooth eliminates the pain at its source and removes any need for opioids.
• C. CORRECT — this is what you must NOT do. Refusing care and dismissing a patient because of suspected substance use is DISCRIMINATORY and abandons someone with a genuine problem who is in genuine pain. Substance use disorder is a medical condition; patients with it retain the right to dental care. Summary dismissal of a patient in active pain also risks a claim of abandonment.
• D. REFERRAL to an appropriate service is appropriate and compassionate. It is legitimate to say plainly that you will not prescribe opioids while offering full dental care and connecting the patient with help.

Note: Both refusal and opioid prescription are wrong. The teachable core is the same: treat the dental cause, use non-opioid analgesia, check the prescription drug monitoring programme, and refer for support without abandoning the patient.