Recently on this website, two articles were published discussing possible opioid abuse stemming from prescriptions given after wisdom teeth surgery, see 1) Persistent Opioid Use After Wisdom Teeth Removal and 2) Opioid Prescriptions From Dental Clinicians for Young Adults and Subsequent Opioid Use and Abuse. The first article discussed a 2018 JAMA article which found that that those who filled an opioid prescription from up to 7 days before until up to 3 days after wisdom teeth removal were 2.69 times as likely than those who did not to continue to fill opioid prescriptions weeks or months later after the wisdom teeth surgery. The second article discussed a 2018 JAMA Internal Medicine article which found that being given opioids by a dentist or oral surgeon for those who had never previously used opioids had higher rates of opioid use at 90 to 365 days later and along with opioid abuse or overdose. These studies have helped show that opioid prescriptions given to teens and young adults following dental care such as wisdom teeth removal has contributed to an opioid addiction and abuse epidemic. Oral surgeons have known for many years that their patients may be getting too many days worth of opioids after wisdom teeth surgery, see What Can a Surgeon Do to Prevent Opioid Abuse. As a result of some of these recent studies and subsequent press coverage, insurance companies in the United States have now decided to limit access to opioids to patients after wisdom teeth removal.
U.S. based health insurance company UnitedHealthcare took action in February 2019, publishing an article titled “The Opioid Epidemic and Its Connection to Dental Care” including an interview from Ted Wong the chief dental officer for UnitedHealthcare. Using their claims data, UnitedHealthcare found that about 70% of its customers received an opioid prescription to deal with pain after wisdom teeth surgery. Further UnitedHealthcare found dental providers write 12% of all opioid prescriptions and around 45% of its adolescent customers recieved opioid prescriptions from dental providers. This has prompted UnitedHealthcare to make the following changes: 1) a prescription drug policy that limits all first-time opioid prescriptions written by dental health professionals for people age 19 and under for no more than three days and less than 50 morphine milligram equivalents per day, 2) informing members on UnitedHealthcare’s dental plan by mail about the risks of opioids in connection with wisdom teeth removal, and 3) providing TV and radio public service announcements. According to UnitedHealthcare’s article cited above, prescribed opioid prescriptions include medications like Vicodin, Percocet, and Tylenol with codeine and alternatively over-the-counter pain relievers like Tylenol and Motrin (acetaminophen and ibuprofen) may provide similar pain relief.
Dr. Wong talked recently with Providence Business News in an article titled “Five Questions With: Dr. Ted Wong” written by Rob Borkowski and published March 17, 2019. He said that studies have shown the likelihood for chronic opioid use increases after the third day and rises rapidly after this period which can lead to opioid addiction and also the craving of other illegal drugs. Dr. Wong states:
“For acute pain, which includes discomfort associated with most dental procedures such as wisdom teeth removal, the CDC [Centers for Disease Control & Prevention] notes a three days’ supply or less of opioids is often all that is needed. That amount is typically enough to provide sufficient pain relief; if people are experiencing significant pain after that, it is likely a sign of a complication, such as an infection or dry socket, and a follow-up visit to a dental professional is the recommended next step rather than the use of additional opioids.”
Providence Business News in the article cited above also asked Dr. Wong an interesting question regarding the timing of wisdom teeth removal, such as what age to remove wisdom teeth at which is a long studied topic, see for example
http://www.teethremoval.com/wisdomteeth.html. Providence Business News’ question was prompted by a study which showed that there is an increased risk of addiction to opioids in adolescents since the pleasure center in the brain doesn’t fully mature until the mid-20s. However, Dr. Wong stated that he did not believe the pain medication taken after surgery should be a deciding factor as to what age wisdom teeth are removed at.
Cigna has also limited it’s opioid prescriptions to no more than a 7 day supply for those who have not taken any opioids within the past 120 days although this began in 2018.
In the past oral surgeons have been worried that regulators and politicians will attempt to limit their ability to provide their patients opioid prescriptions after wisdom teeth removal. However, it appears the dental insurance companies have stepped in to play a role of regulator. In 2018, UnitedHealthcare contacted dental health professionals identified as among the top 10% of the highest opioid prescribers in their network, measured by the number of days per supply and/or morphine milligram equivalents per day. Similarly in 2017, Aetna began sending letters to dental provides who routinely prescribed more than a seven-day supply of opioids for their patients. In both cases the dental professionals were told they were either outliers or among the top of such prescribes in the insurance plan. By limiting the days of opioid given after wisdom teeth surgery and the amount one could argue that the insurance company is getting between the doctor and patient relationship. Of course, it appears that the insurance company would argue they know better than both the doctor and patient and just want to limit future opioid abuse and addiction.
The Kansas City Star, “Teens get addicted to opioids after wisdom teeth removal. Insurers are cracking down,” March. 7, 2019