Opioid Rx From Dentist May Up Rates of Opioid Abuse in Youth .

Dentistry

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Young people with no opioid exposure who received an opioid prescription in a dental setting had higher rates of persistent opioid use and abuse, a retrospective study found.

In a sample of opioid-naive youth, 6.9% (95% CI 6.3%-7.2%, P<0.001) of individuals who received an index opioid prescription filled at least one additional prescription between 90 and 365 days after their initial encounter compared to 0.1% of opioid non-exposed age- and sex-matched controls, reported Alan Schroeder, MD, of Stanford University in California, and colleagues.

The opioid group also had an increase in subsequent diagnoses of opioid abuse (adjusted absolute risk difference 5.3%, 95% CI 5.0%-5.7%, P<0.001), they wrote in JAMA Internal Medicine.

Additionally, a median number of 20 pills were distributed to those who received a second opioid prescription, an "excessive" number which could result in unnecessary distribution to friends or family, the authors noted. These second prescriptions were provided by a dental clinician for 27.0% of patients. The remainder were prescribed by unknown providers, emergency medicine physicians, orthopedic surgeons, and other various healthcare providers, the authors reported.

"It's unclear whether opioids are necessary at all after wisdom teeth extraction and there are some dental professionals that think that ibuprofen or Tylenol are sufficient," Schroeder told MedPage Today. "But even if opioids are necessary in some cases, probably no more than a couple of pills would be sufficient."

While not involved with the research, Chad Brummett, MD, of the University of Michigan Medical School in Ann Arbor, agreed that acetaminophen or Tylenol can usually achieve the same effect as a narcotic after dental surgery, and noted that the fact that nearly one third of adolescents in this study received an opioid from a dental clinician was "quite striking." His past research has demonstrated that individuals specifically undergoing wisdom teeth extraction were at an increased risk for persistent opioid use as well.

"This is another paper that shows similar findings to a number of recent studies, and I hope offers another piece of evidence to make dentists and oral surgeons reflect on their prescribing habits and consider going opioid free in many cases," he told MedPage Today.

Another previous study found that dentists were responsible for 12% of fast-acting opioid prescriptions, behind general practitioners and internists. However, Joel Funari, MS, DMD, of Advanced Oral and Facial Surgery of the Main Line in Devon, Pennsylvania, said that since these numbers were collected, most dentists have significantly changed their prescription habits. There are now certain guidelines that limit the number of narcotics that can be prescribed at one time, for example, and in some states, dental clinicians are required to receive a special certification or obtain written consent from an adolescent's parent or legal guardian before prescribing an opioid to a patient.

"Because of the increased visibility of the opioid crisis and the actions of dental specialty groups, like the American Dental Association, the American Association of Endodontists, and state governments, there's been a significant decrease in the percentage of dentists prescribing these quick-acting narcotics," he told MedPage Today.

For this study, Schroeder's team collected data from the Optum Research Database, which provides claims information for privately insured U.S. citizens across 50 states. Patients were included if they were between ages 16 to 25 at the time of the study (2015), had received an outpatient opioid prescription from a dental clinician that year, and had data in the Optum database for a minimum of 12 months to account for a year-long follow-up. Youth were excluded if they had previous histories of any opioid prescriptions or abuse, or were hospitalized up to 7 days before receiving the initial dental opioid prescription, they wrote.

Of the 14,888 young people included in the opioid cohort, most were white (75.7%) and a slight majority were women (52.9%). Researchers also collected data from 29,776 randomly-selected individuals to create a control group (67.4% white, 52.9% female). The average age across both groups was about 22, and there was one death apiece reported in each cohort.

Female patients were associated with an increased risk of persistent opioid use (aOR 1.2, 95% CI 1.0-1.4), but young adults ages 22 to 25 were less likely to have persistent opioid use than adolescents ages 16 to 18 (aOR 0.7, 95% CI 0.6-0.9).

Not surprisingly, previous non-opioid substance abuse was also linked with persistent opioid use (aOR 3.7, 95% CI 2.9-4.7) and abuse (aOR 4.5, 95% CI 3.4-5.9) after receiving a prescription in the dental setting, the authors noted.

Schroeder and his team acknowledged that some patients likely had preexisting opioid abuse not documented in the claims database. They noted that the full list of codes used to construct a comprehensive list for opioid abuse has not been "validated for medical record review," resulting in potential misclassification. Optum also only includes privately-insured patients, so this study may not be generalizable to patients with Medicaid or other types of insurance, they wrote. Lastly, patients may have fallen out of the study, because the study required participants to have continuous insurance coverage.

Two co-authors received funding from the Department of Pediatrics of Stanford University School of Medicine.

No other disclosures were reported.

2018-12-03T17:30:00-0500