Dental opioid prescribing rates after the up-scheduling of codeine in Australia

Abstract

the misuse of pharmaceutical opioids is a major public health issue. in Australia, codeine was rescheduled on 1 February 2018 to restrict access; it is now only available on prescription. The aim of this study was to measure the change in dental opioid prescriptions, one year before and after the codeine rescheduling in Australia and to assess dental prescribing rates of opioids for 2018 by population and by clinician. Data was extracted for dental opioids for the year immediately prior and after the codeine up-schedule (1 February 2017-31 January 2019) from the publicly-available national prescription database (Pharmaceutical Benefits Scheme). Descriptive statistics, T-tests and odds ratios were used to identify significant prescribing differences. Codeine, codeine/paracetamol, oxycodone and tramadol use increased significantly the year after the codeine restriction than the previous year (13.8-101.1%). Australian dentists prescribed 8.6 prescriptions/1,000 population in 2018, with codeine/paracetamol accounting for most prescriptions (96%). The significant increase in opioid prescribing highlights that Australian dentists may be contributing to the misuse of pharmaceutical opioids. Educational efforts should be targeted at the appropriate use of opioids and patient selection. Dentists should be added to the prescription monitoring system SafeScript so they can make informed decisions for patients who are potentially misusing opioids.

Trends in Dental Medication Prescribing in Australia during the COVID-19 Pandemic

“…In patients without contraindications, nonsteroidal anti-inflammatory drugs are the most appropriate first-line analgesics ( Oral and Dental Expert Group 2019 ). Further education about the appropriate use and limitations of opioids in general dental practice may be warranted ( Teoh et al 2020 ).…”

Prescribing drugs of dependence in dentistry: a review of legal and regulatory considerations

“…6 Comparing the year after the codeine upschedule with the previous year, dispensing of dental prescriptions for the combined product paracetamol with codeine, increased by 21% and oxycodone prescriptions increased by 24%. 7 This is concerning as there is little role for opioids in dentistry, since it is established that non-steroidal anti-inflammatories such as ibuprofen are far more effective for dental pain, [8][9][10] and opioids are only second line agents. 4 The establishment of the National Registration and Accreditation Scheme and formation of the Australian Health Practitioner Regulation Agency occurred in 2010, enabled through near-uniform legislation across the states and territories governing the practise of dental practitioners and other health professionals.…”

“…Codeine was upscheduled on 1 February 2018 to restrict its availability due to concerns with misuse of over‐the‐counter codeine products 6 . Comparing the year after the codeine upschedule with the previous year, dispensing of dental prescriptions for the combined product paracetamol with codeine, increased by 21% and oxycodone prescriptions increased by 24% 7 . This is concerning as there is little role for opioids in dentistry, since it is established that non‐steroidal anti‐inflammatories such as ibuprofen are far more effective for dental pain, 8–10 and opioids are only second line agents 4…”

Questioning the Accuracy and Interpretation of Dispensed Patterns of Dental Emergency Medicines

“…8 The best way for dentists to prevent morbidity and mortality because of opioid overuse and misuse is by appropriate prescribing, patient education, establishing a true therapeutic need, and prescribing minimal quantities to reduce the numbers of leftover pills. 9 …”