Comparison of Opioid Prescribing by Dentists in the United States and England

Abstract

Key Points Question How do opioid prescribing patterns differ between dentists in the United States and dentists in England? Findings In this cross-sectional study of opioid prescribing by dentists in 2016, the proportion of dental prescriptions that were opioids was 37 times greater in the United States than in England. Meaning In light of similar oral health and dentist use between the 2 countries, it is likely that opioid prescribing by US dentists is excessive and could be reduced.

Overprescribing of Opioids to Adults by Dentists in the U.S., 2011–2015

“…Even though nonopioid analgesics have been shown to achieve equivalent or superior pain control for acute oral pain, 43 a recent comparison of opioid prescribing by dentists in the U.S. and England suggests that opioid prescribing by U.S. dentists, especially for high-potency opioids, is excessive. 4 Interventions that have been shown to be effective in curtailing opioid prescribing by dentists include mandatory query of the state prescription drug monitoring program 1 and pharmacist-delivered audit and feedback. 44 However, dentists have low registration and use of prescription drug monitoring programs.…”

“…1−3 Relative to other nations with similar dental care practices, the proportion of prescriptions written by U.S. dentists for opioids is approximately 37 times higher. 4 Most of the postoperative dental pain is acute in nature and accompanied by tissue injury and inflammation. Per the American Dental Association, nonopioid analgesics such as nonsteroidal anti-inflammatory drugs should be considered the drug of choice for acute routine pain management.…”

Commentary on Burke et al. (2020): Safer and less‐frequent opioid prescribing are both essential for US public health

“…However, Burke and colleagues’ study shows that this is not necessarily the case: incident prescription opioid use disorder is being generated among opioid‐naive individuals. In a country where 12% of people visiting the emergency room for a sprained ankle receive an opioid prescription and the per‐capita rate of prescribing for dental procedures is 70 times that of England , ample opportunities are available to safely reduce opioid prescribing outside of the chronic pain population. Further progress in reducing the number of opioid prescriptions, combined with the lowering of risk per prescription documented by Burke et al ., will both be needed to significantly ameliorate the US opioid epidemic.…”

The opioid crisis in the USA

“…These differences are huge despite similar patterns of dental attendance and no significant differences in oral health quality indicators. 5 In the US, dentists prescribe opioids, often very potent opioids, in preference to NSAIDs. While in England and most other parts of the world, dentists overwhelmingly prescribe NSAIDs in preference to opioids.…”