An interesting article titled “Opioid prescribing by oral and maxillofacial surgeons in the United States, 2016–2019” written by Tumader Khouj, Deborah E. Polk, and Katie J. Suda, appears in the October 9th, 2022, issue of the Journal of Public Health Dentistry. The article describes opioid prescribing trends among oral and maxillofacial surgeons (OMFS) in the United States during 2016 to 2019. In the past on this site several articles have covered opioid prescribing habits, see for example Assessing the Impact of Three Day Opioids Limits for Dentists, Insurance Companies Limiting Access to Opioids After Wisdom Teeth Surgery, Reducing Opioids in Oral and Maxillofacial Surgery, and Dentists Overprescribing Opioids to Adults in the U.S..
In the article, the authors conducted a retrospective analysis of IQVIA Longitudinal Prescription Dataset (LRx) from January 1, 2016, to December 31, 2019, that includes 92% of all dispensed outpatient prescriptions in the U.S. The authors restricted the dataset to active oral surgeons and did not include opioid prescriptions not commonly prescribed for pain such as cough suppressant-containing opioids. The research was funded by the the Agency for Healthcare Research and Quality and the U.S. Food and Drug Administration.
The authors found that between 2016 and 2019, oral and maxillofacial surgeons prescribed 13.9 million opioids to 12.5 different million patients. Each year, a median of 3.5 million opioids were prescribed by a median of 5,562 oral surgeons which resulted in a rate of about 627.2 opioids per surgeon each year. From 2016 to 2019, the total number of opioids decreased by 20.4% from 3.9 to 3.1 million opioid prescriptions. The authors further found changing prescribing trends depending on the type of medication. The total number of hydrocodone prescriptions decreased by 20.9%. Oxycodone prescriptions decreased by 39.2%. Prescriptions by oral surgeons for codeine and tramadol increased by 6.1% and 24.3%, respectively.
The rate of prescriptions for oral surgeons descreased from 663.9 opioids per surgeon each year to 2016 to 584.9 opioids per surgeon each year in 2019, a decrease of 27 prescriptions per surgeon each year. The number of patients who received an opioid from an oral surgeon decreased from 585.2 patients per oral surgeon in 2016, to 530.9 patients per surgeon in in 2019, a decrease of 18.6 patients per surgeon each year. Further, the proportion of oral surgeons opioids that exceeded a 3 days supply decreased from 44.3% in 2016 to 29.3% in 2019. From 2016 to 2019 the authors noted that most states in the U.S. saw a decrease in opioids perscribed by an oral surgeon but six states actually saw an increase ranging from 0.4% to 10.5% (Arizona, Arkansas, Kansas, Missouri, Idaho, and Montana).
The authors state:
“Following national trends, [oral and maxillofacial surgeons] opioids havedecreased. Policies and regulations such as prescription drug monitoring programs, CDC guidelines and statements by the American Dental Association (ADA) and the American Association of Oral and Maxillofacial Surgeons [AAOMS] on opioid prescribing may have influenced these trends….opportunities remain to improve high risk and high rates in some states.”
In regards to the increase in prescriptions for codeine and tramadol, the authors state this could be due to their lower potency and fewer restrictions. They mention that codeine is not indicated for children and tramadol is not effective for acute dental pain. Thus they feel these trends should be monitored. The authors mention that in the absence of contraindications, nonsteroidal anti-inflammatory drugs are the most effective and safest option for managing acute dental pain. The authors mention several limitations of their study including that the data did not disclose dental visit information, including procedure type which made it so they could not adjust for patient-level characteristics.