Important Studies on Opioid Prescribing: Implications for Dentistry

Recently on this site several articles have appeared discussing opioid prescribing after wisdom teeth removal see for example the posts Do Oral Surgeons Give Too Many Opioids for Wisdom Teeth Removal? and Opioid Prescriptions From Dental Clinicians for Young Adults and Subsequent Opioid Use and Abuse. Very recently several interesting studies regarding opioid prescribing have published.

The first study is titled “Trends in Opioid Prescribing for Adolescents and Young Adults in Ambulatory Care Settings” written by Hudgins et al. appearing in Pediatrics in June 2019 (vol.143, no. 6, e20181578). The article explored opioid prescribing for adolescents (ages 13 to 17) and young adults (ages 18 to 22) receiving care in emergency departments and outpatient clinics. Data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) and National Ambulatory Medical Care Survey (NAMCS) over the time period from January 1, 2005, to December 31, 2015 was used. It was found the most common conditions associated with opioid prescribing among adolescents visiting emergency departments was dental disorders (59.7%), clavicle fractures (47%) and ankle fractures (38.1%) and among young adults visiting emergency departments was dental disorders (57.9%), low back pain (38%), and neck sprain (34.8%). Thus in both cases when someone ages 13 to 22 goes to an emergency department because of a dental disorder they are nearly 60% likely to leave with an opioid prescription. Studies suggest that adolescents and young adults are the most likely to misuse and abuse opioid medications. Thus the authors imply it is possible that many of these opioids being prescribed for dental disorders are being used for non medical use.

An accompanying commentatory of the article by Hudgins also provides additional insights into the article titled “Opioids and the Urgent Need to Focus on the Health Care of Young Adults” written by Callahan also appearing in Pediatrics in June 2019 (vol. 143, no. 6, e20190835). Callahan says that research looking at young adults is often not available as they often become grouped with adolescents in studies. Callahan states:

“Efforts to improve research and health care for young adults are further hindered by (1) the lack of a consensus definition of young adulthood, (2) the false perception that young adults are healthy, (3) fragmented health insurance coverage during young adulthood, and (4) little organized advocacy on behalf of young adults.”

Callahan thus calls for more research tailored to young adults. Young adults are of course a target demographic for wisdom teeth surgery.

The second study is titled “Comparison of Opioid Prescribing by Dentists in the United States and England” written by Suda et al. appearing in JAMA Network Open in 2019 (vol. 2, no. 5, e194303). The article explored opioid prescribing differences by dentists in the United States of America and England. The authors looked at data from IQVIA LRx in the U.S. and the NHS Digital Prescription Cost Analysis in England. The authors found in 2016 dentists prescribed 11,440,198 opioid prescriptions in the U.S. and 28,082 opioid prescriptions in England. Dental prescriptions for opioids were 37 times greater in the U.S. than in England. In the U.S. various opioids were prescribed including hydrocodone-based opioids (62.3% of time), codeine (23.2% of the time), oxycodone (9.1% of the time), and tramadol (4.8% of the time) whereas in England only the codeine derivative dihydrocodeine was prescribed. The authors state:

“The significantly higher opioid prescribing occurs despite similar patterns of receiving dental care by children and adults, no difference in oral health quality indicators, including untreated dental caries and edentulousness, and no evidence of significant differences in patterns of dental disease or treatment between the 2 countries.”

The authors in the article by Suda point out that the patients included in the study from England were limited to receiving medications from the U.K.’s National Health Service. However they feel that their study shows that U.S. dentists prescribe too many opioids and this practice is contributing to the opioid epidemic in the U.S.

In both studies above it seems that the authors feel that patients in the U.S. are receiving too many opioids for dental related issues and that other medications that can provide pain relief should be given. When opioids are given they should be prescribed in the shortest duration necessary to deal with the expected amount of pain the patient is dealing with. However, a limitation of both studies is the authors were unable to assess the appropriateness of the opioid prescriptions given.