In a study published online by JAMA, Brian T. Bateman, MD, M.Sc., of Brigham and Women’s Hospital, Boston, and colleagues examined nationwide patterns of opioid prescribing following surgical tooth extraction.
Opioid abuse has reached epidemic proportions in the US, and often begins with a prescription for pain medication. Dentists are among the leading prescribers of opioid analgesics, and surgical tooth extraction is one of the most frequently performed dental procedures. Surveys suggest that dental practitioners commonly prescribe opioids following this procedure, despite evidence that a combination of non-steroidal medications and acetaminophen may provide more effective treatment for post-extraction pain.
The researchers collected data from a national database of health claims drawn from Medicaid transactions for the years 2000 to 2010. All patients who underwent dental extraction were included. The frequency of opioid prescriptions filled within seven days of extraction was determined, as was the nature and amount of opioids dispensed.
The analysis included 2,757,273 patients. Within seven days of extraction, 42 per cent of patients filled a prescription for an opioid medication. The most commonly dispensed opioid was hydrocodone (78 per cent of all prescriptions), followed by oxycodone (15 per cent), propoxyphene (3.5 per cent) and codeine (1.6 per cent). Patients aged 14 to 17 years had the highest proportion, who filled opioid prescriptions (61 per cent), followed by patients aged 18 to 24 years.
There was great variability in the amount of opioids dispensed for a given procedure, with an approximately threefold difference between the 10th and 90th percentile in the oral morphine equivalents prescribed. “Although a limited supply of opioids may be required for some patients following tooth extraction, these data suggest that disproportionally large amounts of opioids are frequently prescribed given the expected intensity and duration of post-extraction pain, particularly as non-opioid analgesics may be more effective in this setting,” the authors write.
“This common dental procedure may represent an important area of excessive opioid prescribing in the US. As the nation implements programmes to reduce excessive prescribing of opioid medications, it will be important to include dental care in these approaches.”