Dental opioid prescribing and multiple opioid prescriptions among dental patients

Abstract

Background Despite increased attention to dentists’ role in curbing opioid misuse, abuse, and diversion, information regarding prescribing practices and the frequency of multiple concurrent opioid prescriptions among dental patients is limited. Methods Prescription drug monitoring program (PDMP) data for South Carolina representing dispensed medication for patients prescribed at least one opioid by a dentist over the most recently available two-year frame (2012–2013) was reviewed. Descriptive analyses examined: (1) types, frequency of dental opioid prescriptions; and, (2) frequency of existing multiple concurrent opioid prescriptions among dental patients. Results Nearly all dispensed dental opioid prescriptions (99.9%; n = 653,650) were for immediate release opioids and were initial fills (96.2%). Hydrocodone (76.1%) and oxycodone (12.2%) combination products were the most frequently dispensed opioids prescribed by dentists. Individuals under 21 years of age received 11.2% of dentist prescribed opioids dispensed. Patients with multiple concurrent opioid prescriptions were identified within 30-day (n=113,818), 90-day (n=166,124), and 180-day (n=205,576) timeframes. Conclusions Dentists prescribed a high volume of immediate release opioids dispensed in South Carolina. A notable minority of dental patients had incident(s) of multiple pre-existing opioid prescriptions, a factor implicated in patient misuse, abuse, overdose, and diversion Practical Implications Use of a PDMP prior to prescribing provides a record of controlled substances dispensed to a patient, and may inform prescribing, coordination of care, and addiction screening or referral. Patients should be provided information regarding misuse behaviors and their risks, as well as the importance of secure storage and disposal of leftover opioid medications.

Training Experiences regarding Pain Management, Addiction, and Drug Diversion of Dentists Enrolled in the National Dental Practice-Based Research Network

“…No objective prescribing data were collected; however, dentists’ self-report of prescribing practices in the current study generally correspond with objective reports of dental opioid prescribing. 8 Systemic factors that were not assessed by the current survey could have influenced the findings of this study.…”

Clinical indications associated with opioid initiation for pain management in Ontario, Canada: a population-based cohort study

“…Although the dose and duration of these prescriptions are relatively limited, the concentration of dental prescriptions among younger patients—a group at potentially greater risk of prescription opioid misuse, illicit use, and recreational experimentation— 10 , 30 highlights the importance of policy efforts to ensure that dentist prescribing remains appropriate and necessary. 16 , 17 , 21 …”

Opioid prescribing and risk mitigation implementation in the management of acute pain

“…Consistent with PDMP data regarding dental opioid prescribing practices, the vast majority of dental opioid prescriptions reported in the current study were for immediate-release opioids, including hydrocodone and oxycodone products. 8 These products have high potential for abuse and diversion, as recognized by the re-scheduling of hydrocodone (from Schedule III to Schedule II) in 2014. 25,26…”

“…Dentists prescribe a notable volume of immediate release opioids, accounting for an estimated 12% of annual immediate release opioid prescriptions annually, and prior research suggests that a majority of patients report having unused medication leftover from their post-procedural dental prescription. 8–10 Opioids account for a nearly one-third of prescriptions issued by dentists. 11 Due in large part to the commonality of third molar extraction procedures, dental opioid prescribing is particularly frequent for adolescent patients, a group at increased risk for misuse.…”