Dental practices represent a key battleground in nationwide efforts to reduce opioid use and abuse, according to the University of Michigan, which studied four years of data from 2 million patients.
For example, patients who had dental procedures on a Friday or a day before a holiday were much more likely to fill a prescription for an opioid than other patients. Teens and young adults were the most likely to get opioids, which were likely prescribed to get them through the weekend or holiday break without needing to contact the dentist for pain care.
One in five of the patients, all between the ages of 13 and 64, filled a prescription for an opioid, even though non-opioid pain medication are equally effective at controlling pain and have lower risks.
Those who had pre-weekend or pre-holiday procedures were 27% more likely to pick up an opioid prescription. If they were teens or young adults, they were 43% more likely than older patients to do so.
The research builds on prior work showing overprescribing of opioids by dentists with no increase in pain relief or patient satisfaction.
The rate of weekend and holiday opioid prescription-filling by young people is especially troubling because of previous work showing that those who get opioids after getting their wisdom teeth out are nearly three times as likely to keep refilling the prescription long after their mouths should have healed, the researchers said.
“Variation in opioid prescription fills may put some patients at increased risk,” said Caitlin Priest, the University of Michigan Medical School student who led the analysis as part of the Michigan Opioid Prescribing Engagement Network (OPEN) team.
“Now that we understand that dental opioid prescription fills were increased on Fridays and before holidays, we can create and disseminate best practices to avoid unnecessary prescribing,” Priest said.
Just over half of the patients whose records were analyzed had their dental procedure on an emergency basis. But the rest were scheduled, with one fifth of them on Fridays and the days before holidays.
Half of the patients who filled an opioid prescription had scheduled surgical tooth extractions, but the pre-weekend and pre-holiday increase was seen across all 11 dental procedures studied.
This suggests multiple opportunities to reduce unneeded opioid prescribing, said Romesh Nalliah, MHCM, DDS, associate dean for patient services at the University of Michigan School of Dentistry and a member of the study team. Nalliah said that patients may seek Friday and pre-holiday appointments for scheduled procedures to avoid missing work as they recover.
“The significance of our study is that, with the help of big data, it begins to unpack potentially harmful opioid prescribing trends that were not previously understood,” Nalliah said. “In the event that we have particular concerns about a given case or patient, we can more deliberately book surgeries when we are available to follow up.”
The senior author of the study, Chad Brummett, MD, co-directs Michigan OPEN, which has published evidence-based guidelines for opioid prescribing for acute pain caused by many types of procedures and operations. He also is director of pain research in the Department of Anesthesiology at Michigan Medicine, the university’s academic medical center.
The guidelines say that for dental extractions, non-steroidal anti-inflammatory medications and over-the-counter pain relievers should be sufficiency for pain control.
The study, “Increased Opioid Prescription Fills After Dental Procedures Performed Before Weekends and Holidays,” was published by the Journal of the American Dental Association.