Dental Opioid Prescribing Practices and Risk Mitigation Strategy Implementation: Identification of Potential Targets for Provider-Level Intervention

Abstract

Background Given the regular use of immediate release opioids for dental pain management, as well as documented opioid misuse among dental patients, the dental visit may provide a viable point of intervention to screen, identify, and educate patients regarding the risks associated with prescription opioid misuse and diversion. The aims of this statewide survey of dental practitioners were to assess: (a) awareness of the scope of prescription opioid misuse and diversion; (b) current opioid prescribing practices; (c) use of and opinions regarding risk mitigation strategies; and, (d) use and perceived utility of drug monitoring programs. Methods This cross-sectional study surveyed dentists (N=87) participating in statewide professional and alumni organizations. Dentists were invited via email and listserv announcement to participate in a one-time, online, 59-item, self-administered survey. Results A majority of respondents reported prescribing opioids (n=66; 75.8%). A minority of respondents (n=38; 44%) reported regularly screening for current prescription drug abuse. Dentists reported low rates of requesting prior medical records (n=5; 5.8%). Only 38% (n=33) of respondents had ever accessed a prescription drug-monitoring program (PDMP), and only 4 (4.7%) consistently used a PDMP. Dentists reporting prior training in drug diversion were significantly more likely to have accessed their PDMP, p<0.01. Interest in continuing education regarding assessment of prescription drug abuse/diversion and use of drug monitoring programs was high. Conclusions Although most dentists received training related to prescribing opioids, findings identified a gap in existing dental training in the assessment/identification of prescription opioid misuse and diversion. Findings also identified gaps in the implementation of recommended risk mitigation strategies, including screening for prescription drug abuse, consistent provision of patient education, and use of a PDMP prior to prescribing opioids.

Current prescribing trends of dental non‐antibacterial medicines in Australia from 2013 to 2016. Part 2.

“…Some degree of dependence can develop even after a week of taking opioids regularly . A survey in the USA that assessed dentists’ knowledge and attitudes towards prescribing opioids found that there was a lack of training in the identification of prescription drug abuse and insufficient screening for opioid misuse and diversion . In addition, a study in Boston, Massachusetts, USA, found that approximately 12% of people presenting in the emergency department reporting backache, dental pain or headache were ‘drug seeking’ for an opioid medicine …”

Oral manifestations of illicit drug use

“…Therefore dentists should be aware of the increasing issues relating to prescribing drugs of dependence such as opioids and benzodiazepines and the importance of establishing a true therapeutic need . A cross sectional study of dentists in the US assessing dental opioid prescribing practices found a gap in existing dental training in the identification of prescription opioid diversion and screening for prescription drug abuse . Furthermore, a prospective, observational study of patients who presented at emergency departments in Boston showed that approximately 12% of patients reporting backache, dental pain or headache were ‘drug seeking’ for a medicine of dependence .…”

Prescription Drug Abuse Among Patients in Rural Dental Practices Reported by Members of the National Dental PBRN

“…Medical prescribers’ contribution to the initiation and maintenance of the epidemic has been well documented . Dentists prescribe a notable volume of immediate release opioids, accounting for an estimated 12% of annual immediate release opioid prescriptions . Due in large part to the commonality of third molar extraction procedures, dental opioid prescribing is particularly frequent for adolescent patients, a group at increased risk for misuse …”

“…[6][7][8][9] Dentists prescribe a notable volume of immediate release opioids, accounting for an estimated 12% of annual immediate release opioid prescriptions. [10][11][12][13][14] Due in large part to the commonality of third molar extraction procedures, dental opioid prescribing is particularly frequent for adolescent patients, a group at increased risk for misuse. [15][16][17][18] Rural communities have been particularly hard hit by the opioid epidemic and are disproportionately impacted by opioid-affected births and prescription opioid-related overdose.…”