A significant number of older patients who receive opioids at dental visits also use psychotropic medications, which could be a potentially harmful combination, according to researchers at the University of Illinois at Chicago (UIC) and the University of Pittsburgh.
Rates of polypharmacy, or taking multiple medications, are high among older adults who are more likely to be managing more than one health issue at any given time, the researchers said.
Psychotropic medications that act on the central nervous system such as anti-anxiety or antidepressant medications are especially dangerous if taken with opioids because they can interact with each other and have negative effects, the researchers said.
“Some of the most concerning negative outcomes of these combinations include overdosing on opioids or falling, which can necessitate a visit to the hospital, which in itself carries greater risk for older adults,” said Gregory Calip, PharmD, MPH, PhD, associate professor of pharmacy systems, outcomes, and policy at the UIC College of Pharmacy and corresponding author of the study.
The researchers looked at medical, dental, and pharmacy claims data from 40,800 older adult dental patients who visited a dentist between 2011 and 2015 and were prescribed opioids. The data was from the IBM Watson MarketScan databases.
The average age of the patients in the study was 69, and 45% were female. Of these patients, 10% were taking medications associated with increased risks for harm with opioid prescriptions. There also were 947 hospitalizations or emergency room visits among these patients.
Among patients prescribed opioids by their dentist, one in 10 were already taking a prescription medication that should not be prescribed with opioids.
Also, patients inappropriately prescribed an opioid medication combination by their dentist were 23% more likely to be hospitalized or visit an emergency department in the 30 days after the dental visit where they were prescribed an opioid, compared with dental patients who were not prescribed an opioid medication.
“Dentists are among the top prescribers of opioids,” said Katie Suda, PharmD, MS, professor of medicine at the University of Pittsburgh School of Medicine and principal investigator of the study.
“It seems that the increased messaging regarding limiting opioid prescriptions has been aimed primarily at medical physicians and not tailored to other specialist providers, including dentists. This can have dire consequences,” Suda said.
“As we saw in our study, opioid interactions with other medications was likely responsible for the significant rise in emergency room visits and hospitalizations,” Suda said.
“Although the percentage of opioids prescribed by dentists has decreased in the last 20 years, dentists must continue interprofessional collaboration with primary care physicians, pharmacists, and other healthcare providers to address devastating and preventable drug interactions affecting vulnerable patients who look to them for safe and compassionate care,” said Susan Rowan, DDS, executive associate dean and associate dean for clinical affairs at the UIC College of Dentistry.
The study, “Potentially Inappropriate Medication Combination with Opioids among Older Dental Patients: A Retrospective Review of Insurance Claims Data,” was published by Pharmacotherapy.
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