Opioid prescribing patterns after dental visits among beneficiaries of Medicaid in Washington state in 2014 and 2015

Abstract

Background: Dentists contribute to the prevailing opioid epidemic in the United States. Among the Medicaid population, little is known about opioid prescribing by dentists. Methods: We performed a retrospective cohort study of Washington State Medicaid beneficiaries with dental claims in 2014 and 2015. The primary outcome was the proportion of dental visits associated with an opioid prescription. Visits were categorized as "invasive" or "non-invasive" using procedure codes, and each beneficiary was categorized as "low" or "high-risk" using their prescription history from the Prescription Drug Monitoring Program. Results: 126,660 (10.3%) of all dental visits among the Washington State Medicaid population were associated with opioid prescriptions, most of which were invasive (66.9%). However, noninvasive dental visits, and visits for beneficiaries with a history of prior high risk prescription use, were associated with significantly higher mean days' supply and mean quantity of opioids prescribed. The multivariate logistic regression showed that the probability of having an opioidassociated visit increased by 35.6 percentage points (pp) when the procedures were invasive, or 11.1pp, when the beneficiary had a history of prior high risk prescription use.

Is it time US dentistry ended its opioid dependence?

“…This is concerning, since it suggests the possibility that patients are being offered opioids instead of definitive treatment of their odontogenic pain. 50 Similarly, non-traumatic dental pain accounted for 2.18 million emergency department (ED) visits in 2012, nearly 2% of the total, and 50.3% of them received an opioid prescription compared to just 14.8% of all other ED patients. Indeed, patients who presented to the ED with non-traumatic dental pain were twice as likely to receive an opioid than a non-opioid or no pain medication.…”

Association of sociodemographic factors with the prescription pattern of opioids for dental patients: A systematic review protocol

“…The prescription patterns of these drugs in Dentistry seems to be influenced by many factors, including the type of procedure performed, the patient’s threshold for pain, and sociodemographic characteristics [ 18 – 20 ]. It seems that women are more likely to receive an opioid prescription [ 21 , 22 ]. However, one systematic review reported that an individual’s sex was not identified as an associated factor for opioid prescriptions after surgery or trauma [ 23 ].…”

“…However, one systematic review reported that an individual’s sex was not identified as an associated factor for opioid prescriptions after surgery or trauma [ 23 ]. Compared to white patients, African-Americans are more likely to receive an opioid prescription provided by a dentist [ 22 , 24 ]. Conversely, another study reported that race was not a predictor for opioid prescriptions in Dentistry [ 25 ].…”

“…However, in Australia, living in lower socioeconomic conditions was associated with a higher risk of receiving an opioid prescription [ 6 ]. Regarding dental insurance, the association with opioid use is still unclear [ 18 , 20 , 22 , 24 ].…”

“…Primary studies have assessed the possible influence of sociodemographic factors on the prescription pattern of opioids in Dentistry; however, the evidence produced by such studies seems controversial [ 18 , 20 , 22 , 24 , 25 ]. A preliminary search was conducted in the PROSPERO, MEDLINE (PubMed), and Web of Science databases, and no systematic review on this issue was identified.…”