A randomized pilot program to reduce opioid use following dental surgery and increase safe medication return

Derefinko, Karen J.; García, Francisco I. Salgado; Johnson, Karen C.; Hand, Sarah; Murphy, James G.; McDevitt-Murphy, Meghan E.; Suda, Katie J.; Andrasik, Frank; Bursac, Zoran; Chiu, Chi‐Yang; Talley, Kevin M.; Brooks, Jeffrey H

doi:10.1016/j.addbeh.2019.106190

Cited by 8 publications

(5 citation statements)

References 20 publications

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“…Other observational studies have shown improved awareness about the correct disposal of opioid medications. 29,30 The effectiveness of opioid education interventions in decreasing postoperative opioid consumption could be explained by increased patient engagement and a better understanding regarding the role of nonopioid analgesic modalities, pain expectations, and the potential risk of opioid-related side effects. Based on Table 1, these 3 were the most common topics included in the education interventions and seem to contribute to the reduction in opioid consumption.…”

Section: Discussionmentioning

confidence: 99%

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Effectiveness of Perioperative Opioid Educational Initiatives: A Systematic Review and Meta-Analysis

Zorrilla-Vaca

Mena²,

Ramírez

et al. 2021

Anesthesia &Amp; Analgesia

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BACKGROUND: Opioids are the most commonly prescribed analgesics in the United States. Current guidelines have proposed education initiatives to reduce the risk of chronic opioid consumption, yet there is lack of efficacy data on such interventions. Our study evaluates the impact of perioperative opioid education on postoperative opioid consumption patterns including opioid cessation, number of pills consumed, and opioid prescription refills. METHODS: The MEDLINE/PubMed, Embase, Cochrane Library, Scopus, and Google Scholar databases were systematically searched for randomized controlled trials (RCTs) assessing the impact of perioperative educational interventions (using either paper- or video-based instruments regarding pain management and drug-induced side effects) on postoperative opioid patterns compared to standard preoperative care among patients undergoing elective surgery. Our end points were opioid consumption (number of pills used), appropriate disposal of unused opioids, opioid cessation (defined as no use of opioids), and opioid refills within 15 days, 6 weeks, and 3 months. RESULTS: In total, 11 RCTs fulfilled the inclusion criteria, totaling 1604 patients (804 received opioid education, while 800 received standard care). Six trials followed patients for 15 days after surgery, and 5 trials followed patients up to 3 months. After 15 days, the opioid education group consumed a lower number of opioid pills than those in the control group (weighted mean difference [WMD], −3.39 pills; 95% confidence interval [CI], −6.40 to −0.37; P =.03; I2 = 69%) with no significant difference in overall opioid cessation (odds ratio [OR], 0.25; 95% CI, 0.04–1.56; P = .14; I2 = 83%). Likewise, perioperative opioid education did not have significant effects on opioid cessation at 6 weeks (OR, 0.69; 95% CI, 0.45–1.05; P = .10; I2 = 0%) and 3 months (OR, 0.59; 95% CI,0.17–2.01; P = .10; I2 = 0%) after surgery, neither reduced the need for opioid refills at 15 days (OR, 0.57; 95% CI, 0.28–1.15; P = .12; I2 = 20%) and 6 weeks (OR, 1.08; 95% CI, 0.59–1.98; P = .80; I2 = 37%). There was no statistically significant difference in the rate of appropriate disposal of unused opioids between both groups (OR, 1.99; 95% CI, 0.66–6.00; P = .22; I2 = 71%). Subgroup analysis by type of educational intervention showed a statistical reduction of opioid consumption at 15 days when implementing multimedia/audiovisual strategies (4 trials: WMD, −4.05 pills; 95% CI, −6.59 to −1.50; P = .002; I2 = 45%), but there was no apparent decrease when using only paper-based strategies (2 trials: WMD, −2.31 pills; 95% CI, −12.21 to 7.59; P = .65; I2 = 80%). CONCLUSIONS: Perioperative educational interventions reduced the number of opioid pills consumed at 15 days but did not demonstrate a significant effect on opioid cessation or opioid refills at 15 days, 6 weeks, and 3 months. Further randomized trials should focus on evidence-based educational interventions with strict homogeneity of material to draw a more definitive recommendation.

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Section: Discussionmentioning

confidence: 99%

“…Other observational studies have shown improved awareness about the correct disposal of opioid medications. 29,30…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Perioperative Opioid Educational Initiatives: A Systematic Review and Meta-Analysis

Zorrilla-Vaca

Mena²,

Ramírez

et al. 2021

Anesthesia &Amp; Analgesia

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“…Finally, blister-packaged acetaminophen and ibuprofen has been provided to patients after tooth extraction previously, but the effect on provider behavior has not been measured. In a 2020 study, Derefinko, et al randomized 76 adult patients undergoing dental surgery to an opioid misuse prevention program (n = 34) or treatment as usual (n = 32) [32]. The opioid misuse prevention program consisted of a 10-minute patient education session presented by an interventionalist plus a 7-day supply of acetaminophen and ibuprofen added to usual care.…”

Section: Introductionmentioning

confidence: 99%

Alternatives to dental opioid prescribing after tooth extraction (ADOPT): protocol for a stepped wedge cluster randomized trial

Oyler,

Westgate,

Walsh

et al. 2024

BMC Oral Health

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Background Dentists and oral surgeons are leading prescribers of opioids to adolescents and young adults (AYA), who are at high risk for developing problematic opioid use after an initial exposure. Most opioids are prescribed after tooth extraction, but non-opioid analgesics provide similar analgesia and are recommended by multiple professional organizations. Methods This multi-site stepped wedge cluster-randomized trial will assess whether a multicomponent behavioral intervention can influence opioid prescribing behavior among dentists and oral surgeons compared to usual practice. Across up to 12 clinical practices (clusters), up to 33 dentists/oral surgeons (provider participants) who perform tooth extractions for individuals 12–25 years old will be enrolled. After enrollment, all provider participants will receive the intervention at a time based on the sequence to which their cluster is randomized. The intervention consists of prescriber education via academic detailing plus provision of standardized patient post-extraction instructions and blister packs of acetaminophen and ibuprofen. Provider participants will dispense the blister packs and distribute the patient instructions at their discretion to AYA undergoing tooth extraction, with or without additional analgesics. The primary outcome is a binary, patient-level indicator of electronic post-extraction opioid prescription. Data for the primary outcome will be collected from the provider participant’s electronic health records quarterly throughout the study. Provider participants will complete a survey before and approximately 3 months after transitioning into the intervention condition to assess implementation outcomes. AYA patients undergoing tooth extraction will be offered a survey to assess pain control and satisfaction with pain management in the week after their extraction. Primary analyses will use generalized estimating equations to compare the binary patient-level indicator of being prescribed a post-extraction opioid in the intervention condition compared to usual practice. Secondary analyses will assess provider participants’ perceptions of feasibility and appropriateness of the intervention, and patient-reported pain control and satisfaction with pain management. Analyses will adjust for patient-level factors (e.g., sex, number of teeth extracted, etc.). Discussion This real-world study will address an important need, providing information on the effectiveness of a multicomponent intervention at modifying dental prescribing behavior and reducing opioid prescriptions to AYA. ClinicalTrials.gov NCT06275191.

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“…While opioid overdose deaths remain high in the US at present, with prescription opioids responsible for 24% of opioid deaths in 2020, providers and researchers continue to look for safer ways for opioids to be prescribed [ 20 , 21 , 22 ]. Past over-prescribing and the high distribution of opioids are popularly described as leading to deadly consequences [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

Dynamic Changes in the Distribution of Hydrocodone and Oxycodone in Florida from 2006 to 2021

Stains,

Patel,

Solgama

et al. 2024

Pharmacy

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Background: Florida, which led the country in terms of its number of opioid-prescribing physicians, was unique during the height of the opioid epidemic because of its lax prescribing laws and high number of unregulated pain clinics. Here, we address differences in the distribution rates of oxycodone and hydrocodone across Florida counties during the peak years of the opioid epidemic using an under-utilized database. Methods: The Washington Post and the United States Drug Enforcement Administration’s Automation of Reports and Consolidated Orders System (ARCOS) databases provided longitudinal oxycodone and hydrocodone distribution data in grams per county (2006–2014) and state (2006–2021). Grams of oxycodone and hydrocodone were converted into morphine milligram equivalents (MMEs). Results: There was a steep increase in oxycodone from 2006 to 2010, with a subsequent decline. In 2010, the average MME per person across Florida was 729.4, a 120.6% increase from 2006. The three counties with the highest MMEs per person in 2010 were Hillsborough (2271.3), Hernando (1915.3), and Broward (1726.9), and they were significantly (p < 0.05) elevated relative to the average county. Conclusions: The data demonstrated pronounced differences in opioid distribution, particularly oxycodone, between Florida counties during the height of the opioid epidemic. Legislative action taken between 2009 and 2011 aligns with the considerable decline in opioid distribution after 2010.

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A randomized pilot program to reduce opioid use following dental surgery and increase safe medication return

Cited by 8 publications

References 20 publications

Effectiveness of Perioperative Opioid Educational Initiatives: A Systematic Review and Meta-Analysis

Effectiveness of Perioperative Opioid Educational Initiatives: A Systematic Review and Meta-Analysis

Alternatives to dental opioid prescribing after tooth extraction (ADOPT): protocol for a stepped wedge cluster randomized trial

Dynamic Changes in the Distribution of Hydrocodone and Oxycodone in Florida from 2006 to 2021

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