New Study: Up to Half of Opioids Prescribed at the Time of Dental Visits are Excessive

In this cross-sectional analysis of 542,958 dental visits by adult patients, between 1 in 4 and 1 in 2 opioid prescriptions exceeded the recommended morphine equivalents and days’ supply for acute pain management, respectively.

Between a quarter and half of opioid prescriptions from dental visits exceeded recommendations from prior studies, found the largest study of U.S. commercial dental plan visits investigating the overprescribing of opioids: “Overprescribing of Opioids to Adults by Dentists in the U.S. 2011-2015.” This research was recently published in the American Journal of Preventive Medicine by Center for Research on Health Care and Center for Pharmaceutical Policy and Prescribing authors Katie J. Suda, PharmD, MS and Walid F. Gellad, MD, MPH, among other collaborators.

Between 2011 and 2015, more than 1.4 million patients were prescribed opioids on the day of a dental service. Of those, researchers examined 542,958 cases and found that 29% of prescribed opioids exceed the recommended morphine equivalents. Though this number decreased from 2011 to 2014, it increased in 2015.

Unlike national trends, opioid overprescribing by dentists is increasing. Our results should initiate a call to action to professional organizations and public health and advocacy groups to improve the guidelines for prescribing opioids for oral pain,” explained lead investigator Dr. Suda in the American Journal of Preventive Medicine press release.  “As high prescribers of opioids writing prescriptions for a tenth of the opioids dispensed in the US, dentists should be included as part of the multi-faceted solution needed for the opioid epidemic.

Additionally, consistently over the study period, more than half of the prescriptions exceed the recommended days’ supply. Patients who were most likely to have opioids prescribed inappropriately included patients aged 18 to 34 years, men, patients residing in the Southern U.S., and those receiving oxycodone.

Though the CDC guidelines that informed the researchers’ definition of overprescribing were not published until after the study period, earlier research supported the recommendation that opioids be prescribed for no more than 2 days, even following the procedures with the most potential to cause pain. The researchers suggest that opioid prescribing interventions among dentists may help address dental opioid overprescribing.

Similar to medical providers, dentists need to be provided resources to aid in their prescribing decisions for pain medications,” commented Dr. Suda in the AJPM press release. “This should include clinical guidelines specific to oral pain and education on how to talk to their patients about treating their oral pain.

Additional authors on this research are Jifang Zhou, MD, MPH, Susan Rowan, DDS, and Rosanne I. Perez, BS, of the University of Illinois at Chicago; Jessina C. McGregor, PhD, of Oregon State University,  Charlesnika T. Evans, PhD, MPH, of Hines VA Hospital and Northwestern University; and Gregory S. Calip, PharmD, MPH, PhD, of the University of Illinois at Chicago and the Fred Hutchinson Cancer Research Center.

Research was supported by the Agency for Healthcare Research and Quality.

February 14, 2020 • Michelle Woods