Association of Opioid Prescriptions From Dental Clinicians for US Adolescents and Young Adults With Subsequent Opioid Use and Abuse

Abstract

IMPORTANCE Through prescription writing, dental clinicians are a potential source of initial opioid exposure and subsequent abuse for adolescents and young adults. OBJECTIVE To examine the association between index dental opioid prescriptions from dental clinicians for opioid-naive adolescents and young adults in 2015 and new persistent use and subsequent diagnoses of abuse in this population. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study examined outpatient opioid prescriptions for patients aged 16 to 25 years in the Optum Research Database in 2015. Prescriptions were linked by National Provider Identifier number to a clinician category. EXPOSURES Individuals were included in the index dental opioid (opioid-exposed) cohort if they filled an opioid prescription from a dental clinician in 2015, had continuous health plan coverage and no record of opioid prescriptions for 12 months before receiving the prescription, and had 12 months of health plan coverage after receiving the prescription. Two age-and sex-matched opioid-nonexposed control individuals were selected for each opioid-exposed individual and were assigned a corresponding phantom prescription date. MAIN OUTCOMES AND MEASURES Receipt of an opioid prescription within 90 to 365 days, a health care encounter diagnosis associated with opioid abuse within 365 days, and all-cause mortality within 365 days of the index opioid or phantom prescription date. RESULTS Among 754 002 individuals with continuous enrollment in 2015, 97 462 patients (12.9%) received 1 or more opioid prescriptions, of whom 29 791 (30.6%) received prescriptions supplied by a dental clinician. The opioid-exposed cohort included 14 888 participants (7882 women [52.9%], 11 273 white [75.7%], with mean [SD] age, 21.8 [2.4] years), and the randomly selected opioid-nonexposed cohort included 29 776 participants (15 764 women [52.9%], 20 078 [67.4%] white, with mean [SD] age, 21.8 [2.4] years). Among the 14 888 individuals in the index dental opioid cohort, 1021 (6.9%) received another opioid prescription 90 to 365 days later compared with 30 of 29 776 (0.1%) opioid-nonexposed controls (adjusted absolute risk difference, 6.8%; 95% CI, 6.3%-7.2%), and 866 opioid-exposed individuals (5.8%) experienced 1 or more subsequent health care encounters with an opioid abuse-related diagnosis compared with 115 opioid-nonexposed controls (0.4%) (adjusted absolute risk difference, 5.3%; 95% CI, 5.0%-5.7%). There was only 1 death in each cohort. CONCLUSIONS AND RELEVANCE The findings suggest that a substantial proportion of adolescents and young adults are exposed to opioids through dental clinicians. Use of these prescriptions may be associated with an increased risk of subsequent opioid use and abuse.

Innovations in pre‐doctoral dental education: Influencing attitudes and opinions about patients with substance use disorder

“…By 2010 opioid prescribing by dentists had leveled and began to taper off 17 . Dentists are still the leading source of opioid prescriptions in the younger age group 18,19 and index opioid prescriptions for opioid‐naïve adolescents and young adults have been associated with increased risk of subsequent opioid use and abuse 20 . Furthermore, in a 2016 study, more than half of opioid analgesics prescribed following surgical teeth extractions were left unused, 21 and there is evidence that majority of people who abuse opioid prescriptions source their supplies from leftovers 22 .…”

Prescribing patterns in a US dental school from 2010 to 2017

“…Among all prescriptions written by dentists, 29% are for opioid analgesics, one of the highest proportions across all clinical specialties 6 . Dentists are the highest prescribers of opioids in certain age groups, such as young adults (10 to 19 years), 7 and are also the initial source of opioid exposure for many patients 8 . In fact, recent studies have suggested that among individuals with no prior opioid exposure, prescriptions by dentists may be associated with higher odds of persistent use 8,9 …”

Opioids and Oral Surgery

“…One of the most common procedures that dentists prescribe opioids for in the US, is for surgical tooth removal. Indeed a retrospective investigation of a national sample of privately insured adolescents and young adults, the age most wisdom teeth are surgically removed, showed that prescription of an opioid by a dental clinician was associated with higher rates of opioid abuse or overdose compared with controls.…”

“…So what are the consequences of the liberal use of opiates in oral surgery? In an 18‐year period, there have been 218 000 recorded deaths in the US from opiate overdose. For mothers addicted to opiates, babies become addicted in utero and develop neonatal abstinence syndrome (NAS).…”