Dr. Nathan Whitfield, DMD, MD

In 2018, Nathan Whitfield’s practice stopped writing routine opioid prescriptions after third molar surgery. At the time this was a defensible but lonely position. It has since become considerably less unusual, in part because Whitfield published what replaced it.

The replacement is not a drug but a pathway: pre-operative analgesia, long-acting local anesthetic, and a printed hour-by-hour medication schedule for the first forty-eight hours, so the patient does not have to make a decision at two in the morning. Every surgical patient receives a call the next day from the surgeon or the anesthetist.

Whitfield is careful not to overclaim. “We did not discover anything,” he says. “We wrote down what we were already doing badly, and then did it on purpose.”