Dentists cut opioid prescriptions but still write millions a year
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(Reuters Health) – U.S. dentists wrote 55% fewer opioid prescriptions in 2019 than in 2012, a new study found.
But they still wrote more than 6.9 million prescriptions for opioids in 2019, and 2.7 million of those were for children 17 and younger, who are especially vulnerable to misuse and addiction, researchers reported in the American Journal of Preventive Medicine.
Dr. Alan Schroeder, a pediatrician and Stanford University professor, called the drop from nearly 13 million prescriptions a year to just under 7 million a year “impressive.” He was not involved with the research but studies dental opioid prescribing.
“I’m enthused that there has been progress, albeit only moderate progress,” he told Reuters Health in a phone interview. “I think it shows that maybe when you draw attention to things and have regulatory efforts and guidelines on prescribing, things can change.”
But Dr. Schroeder added: “There’s still a long ways to go. I’m not feeling totally reassured that there’s not a problem with dental opioids and adolescents.”
The number of dental prescriptions written for Americans 65 and older, another vulnerable group, climbed steadily from 10 million in 2012 to 16.5 million in 2019, the study also found.
Researchers examined trends in opioid prescribing by general dentists as well as dental specialists in the U.S. over the eight years using a database that included 92% of all U.S. dispensed outpatient prescriptions.
The data did not, however, include prescriptions written by oral surgeons, an important limitation, according to Dr. Schroeder. He believes oral surgeons write the bulk of opioid prescriptions for adolescents and young adults when they have their wisdom teeth removed.
The study’s principal investigator, Katie J. Suda, and lead author Connie H. Yan acknowledged in a phone interview that oral surgeons perform the majority of third-molar extractions. Suda, a professor at the University of Pittsburgh School of Medicine, and Yan, a pharmacist at the University of Illinois, Chicago, have since obtained data on oral surgeons’ opioid prescriptions and plan to present an analysis of it later this month at the annual meeting of the International Association for Dental Research. (https://bit.ly/3if0ocJ)
The current study found that reductions in dental opioid prescriptions coincided with updated guidelines and statements urging dentists to be cautious in prescribing highly addictive painkillers.
The researchers found greater reductions in prescribing rates after the Centers for Disease Control and Prevention (CDC) published opioid guidelines in March 2016 and the American Dental Association (ADA) issued a statement urging dentists to consider using non-steroidal anti-inflammatory analgesics (NSAIDs) as a first-line treatment for acute pain.
In 2018, the ADA’s expressed support for mandatory continuing education on opioid prescribing and for limits on dosage and duration for the treatment of acute pain might have contributed to additional declines, Yan and Suda wrote. (https://bit.ly/3Ct0erp)
“We all have that experience of having a toothache, and we know how terrible it is, and dentists are trying to alleviate their patients’ pain with the information they currently have available to them,” Suda said in a phone interview.
The FDA and the ADA are currently drafting guidelines for the treatment of acute oral pain, she said.
“Dentists may at times over-perceive the pain,” Yan said. “So dentists may have a tendency to overprescribe.”
Dentists often introduce adolescents and young adults to opioid painkillers when they pull their third molars. Millions of Americans have wisdom teeth extracted every year, and dentists have routinely prescribed opioids following the procedure.
The first prescription can be a powerful predictor of long-term opioid use, Dr. Schroeder found in a 2018 study published in JAMA Internal Medicine. (https://bit.ly/3tN1lxV)
SOURCE: https://bit.ly/3vBhOI8 American Journal of Preventive Medicine, online February 26, 2022.