Trends in National Opioid Prescribing for Dental Procedures among Medicaid Patients

Abstract

BackgroundWe examine trends in opioid prescriptions by dentists for Medicaid-enrolled children and non-senior adults.MethodsWe utilized the IBM Watson Medicaid claims databases for 2012-2019 and the CDC conversion dataset. Opioid prescriptions were linked to a dental visit when prescribed within three days of the dental visit and if the patient had no medical visit reported during that period. We conducted descriptive analyses for age, procedures performed, treatment history, and prescription strength.ResultsOur study showed consistent decreases in opioid prescription rates in dentistry during the study period: from 2.7% to 1.6% among children (0-20), and from 28.6% to 12.2% for adults (21-64). The adult opioid prescription rate fell for nonsurgical dental procedures from 9.7% to 2.9%. For surgical procedures, the adult prescription rate fell from 48.0% to 28.7%. Most dental-related opioids were prescribed for oral surgeries (Children: 70.8%, Adults: 58.6%). By 2019, 23% of all opioid prescriptions for children were dental related.ConclusionWe found that opioid prescription rates in dentistry for Medicaid enrollees declined significantly between 2012 and 2019 for both children and adults. The percent of prescriptions written for nonsurgical visits consistently declined over the observed timeframe. At the same time, opioid prescription rates for both dental surgical procedures and dental nonsurgical procedures decreased as well.Practical ImplicationsAlthough the trends revealed in our analysis show declining opioid prescription patterns, these results suggest that the overall rate is still too high and prescriptions are being written unnecessarily.

Launching an innovative educational model addressing substance use disorders and dental pain management (Project ECHO® in dentistry)

“…Studies have also shown that US dentists have an exaggerated perception of the level of pain associated with dental procedures compared with what patients actually experience [12,13], and almost a third of opioids prescribed are for non-surgical dental care [4]. Although opioid prescription rates in dentistry for Medicaid enrollees declined significantly between 2012 and 2019, the overall rate is still high and prescriptions are being written unnecessarily [14,15]. Dental pain management in patients with substance use disorders is particularly challenging due to factors like multiple medical conditions and drug use, social history, concurrent chronic pain management by other providers, worries of drug misuse and diversion; and relapse during recovery [16].…”