PainRelief.com Interview with:
Kao-Ping Chua, M.D., Ph.D.
Assistant Professor, Department of Pediatrics
Susan B. Meister Child Health Evaluation and Research Center
University of Michigan
PainRelief.com: What is the background for this study?
Response: Persistent opioid use occurs when opioid-naïve patients prescribed opioids after procedures continue to fill opioid prescriptions well past the time that acute post-procedural pain typically resolves. Studies have shown that privately insured adolescents and young adults undergoing wisdom tooth removal are more likely to develop persistent opioid use if they fill opioid prescriptions after the procedure than if they do not. However, it is unknown whether these findings generalize to a broader variety of dental procedures or to publicly insured patients covered by Medicaid.
PainRelief.com: What are the main findings?
Response: Using 2014-2018 commercial and Medicaid claims data, we identified 1.7 million privately and publicly insured patients aged 13-64 years undergoing one of 120 dental procedures. Overall, 1.3% of patients developed persistent opioid use (defined as filling at least one opioid prescription 4-90 days after the procedure and at least one opioid prescription 91-365 days after the procedure). This risk was 2.1% versus 1.0% among patients who did and did not fill opioid prescriptions after the procedure. After controlling for patient demographics, co-morbidities, and procedure type, the adjusted risk of persistent opioid use was 1.5 percentage points higher when dental opioid prescriptions were filled.
Importantly, we also found that the adjusted risk of persistent opioid use associated with filling dental opioid prescriptions was 1.0 percentage points higher among the publicly insured compared with the privately insured.
PainRelief.com: What should readers take away from your report?
Response: These findings suggest that the risk of persistent opioid use associated with dental opioid prescriptions is higher than previously suggested by prior studies that only included the privately insured. The 1.0 percentage point difference appears to be small, but when considering the fact that 11 million opioid prescriptions from dentists are dispensed each year in the U.S., a risk difference of that magnitude translates to substantial excess number of cases of persistent opioid use. Our findings further highlight the importance of avoiding opioid prescribing after dental procedures when non-opioids such as ibuprofen and acetaminophen are effective options for pain control, as is the case for the vast majority of dental procedures.
PainRelief.com: What recommendations do you have for future research as a result of this work?
Response: The vast majority of national studies on the risk of persistent opioid use after surgery have relied on commercial claims data and consequently have not included the publicly insured. If our findings generalize to surgical procedures, then the risk of surgical opioid prescribing may be greater than previously appreciated. This is a possibility we are actively investigating.
Chua K, Hu H, Waljee JF, Nalliah RP, Brummett CM. Persistent Opioid Use Associated With Dental Opioid Prescriptions Among Publicly and Privately Insured US Patients, 2014 to 2018. JAMA Netw Open. 2021;4(4):e216464. doi:10.1001/jamanetworkopen.2021.6464
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