Comparing Narcotic Prescribing Habits For Oral Surgeons in the U.S. and Canada

In a previous blog post titled “Do Oral Surgeons Prescribe Too Many Narcotics for use after Wisdom Teeth Removal?” the issue explored was that of whether or not oral surgeons prescribe more than an adequate amount of narcotic pain killers to young adults after wisdom teeth extraction. The article that found around 25% or so of the study respondents prescribe what the authors of the article declared as too many narcotics to control pain which opened the possibility of non-medical use. A new article titled “Comparison of Narcotic Prescribing Habits and Other Methods of Pain Control by Oral and Maxillofacial Surgeons in the United States and Canada,” sought to explore whether Canadian oral surgeons have similar narcotic prescribing habits. This article was written by Bruce R. Pynn and Daniel M. Laskin and appeared in the December 2014 issue of the Journal of Oral and Maxilofacial Surgery (vol. 72, issue 12).

In this article an 8-question survey similar to the one used in the previous 2013 study was sent to the 336 members of the Canadian Society of Oral and Maxillofacial Surgeons. A total of 158 surveys were returned (47% response rate) with 136 of these fully completed. Some of the results of the study included 1) that only 11 of the 158 respondents (7%) said they did not prescribe a narcotic for patients after wisdom teeth removal, 2) that codeine was the most frequently prescribed analgesic with the most often used dose of 30 mg, and 3) that 80% of those who prescribed narcotics also had patients use a nonsteroidal anti-inflammatory drug (NSAID) postoperatively.

The authors found that a larger percentage of Canadian oral surgeons versus U.S. oral surgeons prescribed steroids (86 vs 80%; P= .0380) and that Canadian oral surgeons more commonly recommended the use of an NSAID in addition to a narcotic postoperatively (80 vs 66%; P< .0001). The authors further found that the most popular narcotic prescribed in Canada was codeine whereas in the U.S. it was hydrocodone (80%). In the United States, codeine was prescribed by only 2% of the study respondents while in Canada it was prescribed by 70% of the study respondents. In both countries oxycodone was the second drug of choice. The most common number of tablets of narcotic prescribed was 20 in the United States versus 30 in Canada although this was mostly explained by the fact that codeine is a weaker narcotic than hydrocodone so more tablets would be needed for codeine (which was the narcotic of choice in Canada).

In the article the authors do question whether or not the 30 tablets most commonly prescribed of codeine by oral surgeons in Canada after wisdom teeth removal is really necessary or if it opens the way for non-medical use. Even so since codeine is not as strong of a narcotic as others it is less likely to lead to abuse.