Sex and race or ethnicity disparities in opioid prescriptions for dental diagnoses among patients receiving Medicaid

Janakiram, Chandrashekar; Chalmers, Natalia I.; Fontelo, Paul; Huser, Vojtech; Mitnik, Gabriela Lopez; Iafolla, Timothy; Brow, Avery; Dye, Bruce A.

doi:10.1016/j.adaj.2018.02.010

Cited by 28 publications

(16 citation statements)

References 34 publications

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“…Similar to the results of our study, several other investigations have identified female sex as a risk factor for opioid exposure or persistent use. 18,[24][25][26] In our study, the aOR for subsequent abuse among women was 11.5 (95% CI, 9.4-14.8). That this aOR was higher than that for persistent use (aOR, 1.2; 95% CI, 1.0-1.4) may in part be explained by the time windows for exposure being different for these 2 outcomes.…”

Section: Discussionmentioning

confidence: 47%

“…For the 745 second opioid prescriptions not provided by a dental clinician, the leading clinician-type categories were unknown prescriber (n = 134), emergency medicine physician (n = 132), orthopedic surgeon (n = 69), physician assistant (n = 58), otolaryngologist (n = 55), family practitioner (n = 50), obstetrician/gynecologist (n = 34), general surgeon (n = 25), and general internist (n = 24). A median (interquartile range) of 20 (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28) pills were dispensed for the second opioid prescription; this number of pills did not differ between dental and nondental clinicians. Because opioid-exposed patients had initial dental visits and opioid-nonexposed individuals may not have had dental visits, we also examined subsequent opioid prescriptions from nondental clinicians among individuals who received nonopioid prescriptions (eg, antibiotics) from dental clinicians.…”

Section: Resultsmentioning

confidence: 99%

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Association of Opioid Prescriptions From Dental Clinicians for US Adolescents and Young Adults With Subsequent Opioid Use and Abuse

et al. 2019

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IMPORTANCE Through prescription writing, dental clinicians are a potential source of initial opioid exposure and subsequent abuse for adolescents and young adults. OBJECTIVE To examine the association between index dental opioid prescriptions from dental clinicians for opioid-naive adolescents and young adults in 2015 and new persistent use and subsequent diagnoses of abuse in this population. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study examined outpatient opioid prescriptions for patients aged 16 to 25 years in the Optum Research Database in 2015. Prescriptions were linked by National Provider Identifier number to a clinician category. EXPOSURES Individuals were included in the index dental opioid (opioid-exposed) cohort if they filled an opioid prescription from a dental clinician in 2015, had continuous health plan coverage and no record of opioid prescriptions for 12 months before receiving the prescription, and had 12 months of health plan coverage after receiving the prescription. Two age-and sex-matched opioid-nonexposed control individuals were selected for each opioid-exposed individual and were assigned a corresponding phantom prescription date. MAIN OUTCOMES AND MEASURES Receipt of an opioid prescription within 90 to 365 days, a health care encounter diagnosis associated with opioid abuse within 365 days, and all-cause mortality within 365 days of the index opioid or phantom prescription date. RESULTS Among 754 002 individuals with continuous enrollment in 2015, 97 462 patients (12.9%) received 1 or more opioid prescriptions, of whom 29 791 (30.6%) received prescriptions supplied by a dental clinician. The opioid-exposed cohort included 14 888 participants (7882 women [52.9%], 11 273 white [75.7%], with mean [SD] age, 21.8 [2.4] years), and the randomly selected opioid-nonexposed cohort included 29 776 participants (15 764 women [52.9%], 20 078 [67.4%] white, with mean [SD] age, 21.8 [2.4] years). Among the 14 888 individuals in the index dental opioid cohort, 1021 (6.9%) received another opioid prescription 90 to 365 days later compared with 30 of 29 776 (0.1%) opioid-nonexposed controls (adjusted absolute risk difference, 6.8%; 95% CI, 6.3%-7.2%), and 866 opioid-exposed individuals (5.8%) experienced 1 or more subsequent health care encounters with an opioid abuse-related diagnosis compared with 115 opioid-nonexposed controls (0.4%) (adjusted absolute risk difference, 5.3%; 95% CI, 5.0%-5.7%). There was only 1 death in each cohort. CONCLUSIONS AND RELEVANCE The findings suggest that a substantial proportion of adolescents and young adults are exposed to opioids through dental clinicians. Use of these prescriptions may be associated with an increased risk of subsequent opioid use and abuse.

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Section: Discussionmentioning

confidence: 47%

Section: Resultsmentioning

confidence: 99%

Association of Opioid Prescriptions From Dental Clinicians for US Adolescents and Young Adults With Subsequent Opioid Use and Abuse

et al. 2019

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“…ED physicians) wrote significantly more opioid prescriptions for dental diagnoses compared to dentists (Odds ratio: 4.66; 95% CI: 4.59-4.74). 63 The findings from these studies underscore the importance of recent policy initiatives recommending continuing education about safe opioid prescribing for acute and post-procedural dental pain. 28 While a prescription for an opioid may be warranted when performing invasive procedures, opioids are rarely ever needed for non-invasive dental procedures and not recommended as the first line of treatment for acute dental pain unless there are contra-indications for nonsteroidal anti-inflammatory drugs (NSAIDs).…”

Section: Discussionmentioning

confidence: 86%

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

Obadan‐Udoh¹,

Lupulescu-Mann²,

Charlesworth³

et al. 2019

The Journal of the American Dental Association

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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.

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“…Many CYSHCN were exposed to opioids by health care providers, including ED clinicians and dentists, who, because of their typical role and setting in the health care system, may either not have been ideally positioned to achieve strong longitudinal knowledge of the children's past medical history (ie, CCCs, polypharmacy, etc) or current overall health and well-being, or situated to provide follow-up. 30,31 These patient attributes may be particularly important to contemplate when choosing which medication(s) to prescribe for pain in CYSHCN. Although certain chronic conditions (eg, sickle cell anemia) may necessitate opioid therapy, 32 a number of prescriptions were preceded by diagnoses not synonymous with pain (eg, respiratory infections).…”

Section: Discussionmentioning

confidence: 99%

Outpatient Prescription Opioid Use in Pediatric Medicaid Enrollees With Special Health Care Needs

et al. 2019

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BACKGROUND AND OBJECTIVES: Although potentially dangerous, little is known about outpatient opioid exposure (OE) in children and youth with special health care needs (CYSHCN). We assessed the prevalence and types of OE and the diagnoses and health care encounters proximal to OE in CYSHCN. METHODS: This is a retrospective cohort study of 2 597 987 CYSHCN aged 0-to-18 years from 11 states, continuously enrolled in Medicaid in 2016, with $1 chronic condition. OE included any filled prescription (single or multiple) for opioids. Health care encounters were assessed within 7 days before and 7 and 30 days after OE. RESULTS: Among CYSHCN, 7.4% had OE. CYSHCN with OE versus without OE were older (ages 10-18 years: 69.4% vs 47.7%), had more chronic conditions ($3 conditions: 49.1% vs 30.6%), and had more polypharmacy ($5 other medication classes: 54.7% vs 31.2%), P , .001 for all. Most (76.7%) OEs were single fills with a median duration of 4 days (interquartile range: 3-6). The most common OEs were acetaminophen-hydrocodone (47.5%), acetaminophen-codeine (21.5%), and oxycodone (9.5%). Emergency department visits preceded 28.8% of OEs, followed by outpatient surgery (28.8%) and outpatient specialty care (19.1%). Most OEs were preceded by a diagnosis of infection (25.9%) or injury (22.3%). Only 35.1% and 62.2% of OEs were associated with follow-up visits within 7 and 30 days, respectively. CONCLUSIONS: OE in CYSHCN is common, especially with multiple chronic conditions and polypharmacy. In subsequent studies, researchers should examine the appropriateness of opioid prescribing, particularly in emergency departments, as well as assess for drug interactions with chronic medications and reasons for insufficient follow-up. WHAT'S KNOWN ON THIS SUBJECT: Outpatient prescription opioid use in children is associated with harmful consequences, including increased emergency department visits and critical care hospitalizations. Children and youth with special health care needs (CYSHCN) frequently use medications, yet little is known about their use of opioids. WHAT THIS STUDY ADDS: Approximately 7% of all CYSHCN and 14% of CYSHCN with a complex chronic condition received $1 opioid annually in the outpatient setting. Only 35% and 62% of opioid exposures were associated with follow-up visits within 7 and 30 days, respectively.

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Sex and race or ethnicity disparities in opioid prescriptions for dental diagnoses among patients receiving Medicaid

Cited by 28 publications

References 34 publications

Association of Opioid Prescriptions From Dental Clinicians for US Adolescents and Young Adults With Subsequent Opioid Use and Abuse

Association of Opioid Prescriptions From Dental Clinicians for US Adolescents and Young Adults With Subsequent Opioid Use and Abuse

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

Outpatient Prescription Opioid Use in Pediatric Medicaid Enrollees With Special Health Care Needs

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