The United States is battling a severe opioid epidemic, and prescriptions written to alleviate dental pain continue to play a part. In 2015, more than 12 million people misused opioids nationwide, and more than 33,000 died from opioid overdoses. Statistics show that dentists have written a declining portion of all opioid prescriptions in recent years, but two new studies highlight the continued need for cautious prescribing.
One study published in April in The Journal of the American Dental Association (JADA) assesses prescribing patterns for dentists caring for patients with private insurance. The authors found that the rate of opioid prescriptions per 1,000 patients rose from 131 to 147 in 2010-15. The largest increase was among 11- to 18-year-olds, for whom the prescription rate grew by nearly two-thirds. For all age groups, nearly one-third of the opioid prescriptions written by dentists were for nonsurgical visits. The authors suggest that dentists could prescribe non-opioid pain relief in more of these instances.
Another study, also published in JADA in April, looks at Medicaid patients who sought outpatient dental care. The authors found that from 2013 to 2015, almost a quarter of such patients filled an opioid prescription. Emergency department (ED) health care providers were much more likely to prescribe opioids to patients with dental conditions; 38 percent of patients who received care in the ED filled an opioid prescription, compared with 11 percent who went to the dentist. The data suggest that emergency health care practitioners and dentists diagnose oral health problems differently, which can lead to unnecessary opioid use.
These studies underscore opportunities to reduce opioid prescription rates with targeted prescribing efforts and guidelines. The results are timely because the American Dental Association recently released an interim policy on opioid prescribing.
The policy supports mandatory continuing education for dentists on prescribing opioids, as well as statutory limits on opioid dosage and duration that is consistent with Centers for Disease Control and Prevention guidelines (no more than seven days). It also supports the use of state prescription drug monitoring programs.
Jane Koppelman directs research for The Pew Charitable Trusts’ dental campaign.