PainRelief.com Interview with:
Kao-Ping Chua, MD, PhD
Susan B. Meister Child Health Evaluation and Research Center
Department of Pediatrics, University of Michigan Medical School
Ann Arbor MI 48109.
PainRelief.com: What is the background for this study?
Response: Prior studies suggest that opioid prescriptions for surgical procedures are associated with increased overdose risk in patients. Additionally, studies suggest that opioid prescriptions are associated with increased overdose risk in patients’ family members, who often have access to patients’ opioids. However, studies have not specifically assessed whether opioid prescriptions for dental procedures are associated with increased overdose risk in patients and their family members.
PainRelief.com: What are the main findings?
Response: In this study, we analyzed the 2011-2018 IBM MarketScan Dental, Commercial, and Medicaid Multi-State Databases, which contain claims from privately insured and publicly insured non-elderly patients. In one analysis, we identified dental procedures for privately and publicly insured patients aged 13-64 years. We found that the adjusted 90-day risk of opioid overdose was higher when patients filled opioid prescriptions within 3 days of the procedure. This additional risk was even greater among patients with Medicaid insurance and those who had mental health or substance use disorders.
In the second analysis, we identified dental procedures for privately insured patients in family plans. We found that the adjusted 90-day risk of opioid overdose in at least one family member was similarly higher when patients filled opioid prescriptions within 3 days of the procedure.
PainRelief.com:What should readers take away from your report?
Response: Opioid overdose is a rare event – yet it is one of the most devastating potential consequences of opioid prescriptions. Our findings indicate that the risk of this event is higher in patients and their family members when dental opioid prescriptions are filled. Given the frequency of dental opioid prescribing in the U.S. – approximately 11 million prescriptions per year – the estimated risk difference in this study could potentially translate to 1,700 additional overdoses among U.S. patients per year. Our findings further underscore the importance of avoiding opioid prescribing for dental procedures when non-opioids like ibuprofen are equally effective for pain, as is the case for the majority of routine dental procedures. When opioids are needed for patients at high risk of overdose, such as those with mental health or substance use disorders, our findings also suggest that dentists should consider implementing measures to mitigate overdose risk, such as naloxone co-prescribing.
PainRelief.com: What recommendations do you have for future research as a result of this study?
Response: The literature has now explicitly demonstrated that dental opioid prescriptions are associated with a variety of adverse events, including overdose and persistent opioid use. Our prior work indicates that approximately two-thirds of dental opioid prescriptions are written for tooth extraction, a procedure for which opioids are not better than non-opioids for pain. This suggests we could dramatically reduce dental opioid prescriptions and their associated harms by eliminating routine prescribing just for this procedure. The question for researchers, policymakers, and dental practitioners now becomes: which interventions, whether policy or clinical, are most effective in achieving this goal?
Dental Opioid Prescriptions and Overdose Risk in Patients and Their Families
Chua, Kao-Ping et al.
American Journal of Preventive Medicine, Volume 0, Issue 0
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