Dentists in the United States write 37 times more opioid prescriptions than those practicing in England, and the opioids they prescribe have a higher potential for abuse, report researchers at the University of Illinois at Chicago (UIC) and the University of Sheffield.
The study suggests that policymakers and professional associations should discuss measures to reduce opioid prescriptions by dentists, who are among the top prescribers of opioids in the United States, according to the researchers.
“To see such a difference between two groups of dentists in countries with similar oral health and use of dentists is an indicator that opioid prescribing practices in the US warrant a second look,” said corresponding author Katie Suda, PharmD, MS, associate professor of pharmacy systems, outcomes, and policy at the UIC College of Pharmacy.
“This study tells us that efforts to adopt national guidelines for treating dental pain and for promoting conservative opioid prescribing practices among dentists in the US should be a priority and should be included as part of more comprehensive judicious opioid prescribing strategies,” said Suda.
The researchers analyzed nationally representative databases from both countries of prescriptions dispensed from retail pharmacies, including community and mail service pharmacies, and outpatient clinic pharmacies in 2016, which is considered a peak point in the opioid crisis in the United States.
Dentists in the United States wrote 1.4 million opioid prescriptions while those in England only wrote 28,000. This result remained even when the researchers adjusted for differences in population size and number of dentists.
Also, dentists in the United States prescribed a much wider range of opioids, while those in the England only prescribed a codeine derivative called dihydrocodeine, which is the only opioid included in the formulary used by England’s National Health Service.
The most commonly prescribed opioids in the United States were hydrocodone-based, followed by codeine, oxycodone, and tramadol. One in 10 opioids prescribed by US dentists were opioids with a high potential for abuse and diversion, such as oxycodone and long-acting opioids. Dentists in England did not prescribe these opioids.
“Dentists need to be part of the opioid conversation. It is common for people to overlook dental issues until pain becomes severe and major interventions are needed,” said coauthor Susan Rowan, DDS, executive associate dean and associate dean for clinical affairs at the UIC College of Dentistry.
“Painkillers are often an essential part of dental care and provider flexibility in choice is important, but this study shows us there is room for dental care providers to contribute to and inform abuse reduction programs,” said Rowan.
“This data should be a wakeup call to individual dental practices and collaborative organizations of dental care providers to push the envelope towards greater efforts to reduce opioid prescribing or patients’ potential for abuse,” said Rowan.
“I was shocked to discover the high level of opioid prescribing of my US dental colleagues. Particularly, when there is good evidence that NSAIDs and acetaminophen are as good or better than opioids for treating dental pain and don’t cause the unpleasant side effects, addiction, and misuse problems associated with opioids,” said coauthor Martin Thornhill, MBBS, BDS, PhD, MSc, professor of translational research in dentistry at the University of Sheffield.
“UK dentists manage exactly the same pain problems as their US colleagues and achieve high levels of patient satisfaction using NSAIDs and acetaminophen without the need to resort to opioids,” said Thornhill.
The study, “Comparison of Opioid Prescribing by Dentists in the United States and England,” was published by JAMA Network Open.