Overprescribing of Opioids to Adults by Dentists in the U.S., 2011–2015

Abstract

Introduction: Dentists prescribe 1 in 10 opioid prescriptions in the U.S. When opioids are necessary, national guidelines recommend the prescription of low-dose opioids for a short duration. This study assesses the appropriate prescribing of opioids by dentists before guideline implementation. Methods: The authors performed a cross-sectional analysis of a population-based sample of 542,958 U.S. commercial dental patient visits between 2011 and 2015 within the Truven Health MarketScan Research Databases (data analysis October 2018-April 2019). Patients with recent hospitalization, active cancer treatment, or chronic pain conditions were excluded. Prescription opioids were ascertained using pharmacy claims data with standardized morphine equivalents and recorded days' supply. Appropriate prescribing was determined from the 2016 Centers for Disease Control and Prevention guidelines for pain management based on a recommended 3 days' supply of opioid medication and anticipated post-procedural pain. Results: Twenty-nine percent of prescribed opioids exceeded the recommended morphine equivalents for appropriate management of acute pain. Approximately half (53%) exceeded the recommended days' supply. Patients aged 18−34 years, men, patients residing in the Southern U.S., and those receiving oxycodone were most likely to have opioids prescribed inappropriately. The proportion of opioids that exceed the recommended morphine equivalents increased over the study period, whereas opioids exceeding the recommended days' supply remained unchanged. Conclusions: Between 1 in 4 and 1 in 2 opioids prescribed to adult dental patients are overprescribed. Judicious opioid-prescribing interventions should be tailored to oral health conditions and dentists.

Potentially Inappropriate Medication Combination with Opioids among Older Dental Patients: A Retrospective Review of Insurance Claims Data

“…1,2 Opioid use is common among older patients given the increasing prevalence of medical conditions associated with acute and/or chronic pain, including opioids prescribed in dental settings. [3][4][5][6][7] Rates of polypharmacy are high among older patients, 8 often a result of necessary medication management of multiple comorbidities. 9 However, this is problematic due to increased risk for medication-associated adverse effects and drug-drug interactions.…”

“…The United States is experiencing a devastating public health crisis that causes over 33,000 deaths annually related to opiate analgesics 1,2 . Opioid use is common among older patients given the increasing prevalence of medical conditions associated with acute and/or chronic pain, including opioids prescribed in dental settings 3–7 . Rates of polypharmacy are high among older patients, 8 often a result of necessary medication management of multiple comorbidities 9 .…”

Trends in National Opioid Prescribing for Dental Procedures among Medicaid Patients

“…15 A 2020 study based on over half a million adult dental visits found that 29.3% of dental opioid prescriptions exceeded the MME-based recommendation, while 53% exceeded the recommended days' supply. 16 Hydrocodone, an opium-based analgesic, is associated with the greatest number of opioid deaths. 17 Together with oxycodone, it remains one of the most commonly prescribed medications by dentists.…”

Assessment of Controlled Substance Distribution to U.S. Veterinary Teaching Institutions from 2006 to 2019

“…The DEA production quotas from 2010 to 2020 decreased by 22.4% for codeine, 35.9% for oxycodone, 36.7% for hydrocodone, and 43.1% for fentanyl relative to only 7.7% for pentobarbital (10)(11). At the same time, there has been an increased attention to the development of more cautious prescribing practices by general practitioners (12), surgeons (13), emergency medicine specialists (14), and dentists (15).…”