Trends in national opioid prescribing for dental procedures among patients enrolled in Medicaid

Okunev, Ilya; Frantsve‐Hawley, Julie; Tranby, Eric

doi:10.1016/j.adaj.2021.04.013

Cited by 11 publications

(12 citation statements)

References 19 publications

(25 reference statements)

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“…This was evidenced by a substantial reduction in opioid prescribing from the baseline study period (measured prospectively for 12 months starting in January 2019) and practices in the prior year (which informed some of our design decisions surrounding power and sample size). Our findings are consistent with recent research indicating that patterns of opioid prescribing in dentistry are influenced by type of extraction and that opioid prescribing overall has decreased in recent years in the wake of national practice guidelines and state legislation [ 8 , 15 , 21 ].…”

Section: Discussionsupporting

confidence: 92%

“…Thus, in most clinical circumstances surrounding post-extraction pain, the NSAID-acetaminophen combination represents a safe and effective alternative to opioids. Nevertheless, although opioid prescribing in dentistry has been decreasing in recent years [ 8 , 15 ] (consistent with trends in the US healthcare system as a whole), many dentists continue to prescribe opioids routinely [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

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De-Implementing Opioids for Dental Extractions (DIODE): a multi-clinic, cluster-randomized trial of clinical decision support strategies in dentistry

et al. 2023

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Background Opioid pain relievers are commonly prescribed following dental extractions, but evidence shows that non-opioid analgesics often provide adequate pain relief with fewer risks. The current study examined clinical decision support (CDS) as a tool for de-implementing opioid prescribing in dentistry. Methods This prospective, cluster-randomized trial examined CDS for dental pain management at 22 HealthPartners Dental Group clinics in Minnesota. Dental providers (n = 49) were randomized to deliver care using CDS, CDS with patient education materials (CDS-E), or standard practice (SP). Randomization was stratified by provider type (dentist vs. oral surgeon) and baseline opioid prescribing volume. Patient records of dental extractions were examined for January 2019 through May 2021, representing a 12-month baseline and 15-month intervention period (N = 12,924). Opioid prescription at the visit (no vs. yes) was the primary outcome. Data were analyzed using generalized linear mixed models, adjusting for patient sex and age, extraction complexity, and baseline prescribing strata (volume and provider type). Results Patients were 56.2% female, with a mean age of 46.7 (SD = 20.0) years. Providers were 8% oral surgeons, 57% female, and with a mean age of 43.7 (SD = 11.2) years. There were significant decreases in opioid prescribing during the study (P < 0.001), representing a continuation of pre-existing trends to reduce opioid prescribing in these dental practices. There were no significant differences in opioid prescribing between CDS and SP (OR = 1.29; 97.5% CI = 0.93, 1.79; P = 0.08), or CDS-E and SP arms (OR = 1.27; 97.5% CI = 0.86, 1.79; P = 0.18). The direction of the association favored greater reductions in opioid prescribing in the SP arm. Despite training and implementation support, utilization of the CDS was low, particularly among oral surgeons, who were significantly more likely than other dentists to prescribe opioids. Among non-oral surgeon providers with the opportunity to access it, CDS utilization was not significantly associated with opioid prescribing. Conclusions Equipping dentists with CDS resources, whether alone or accompanied by patient education materials, did not accelerate reductions in opioid prescribing beyond those observed in standard practice. Strategies are needed to enhance CDS utilization for patient care and safety surrounding analgesia following dental extractions. Trial registration Clinicaltrials.gov, NCT03584789.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

De-Implementing Opioids for Dental Extractions (DIODE): a multi-clinic, cluster-randomized trial of clinical decision support strategies in dentistry

et al. 2023

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“…Dental pain was associated with the highest proportion of unused opioids, consistent with long‐standing calls to reduce prescribing in this population. As in other specialties, prescribing in dentistry has been declining over time 45 ; however, rates remain high. 46 , 47 Miller et al 46 found that 74.9% of analgesic prescriptions written between 2013 and 2018 were for opioids; in an American national survey of dentists, 47 50% of those reporting prescribing opioids were doing so in amounts exceeding what was required, and 69% reported having had patients who had diverted or used their opioids non‐medically.…”

Section: Discussionmentioning

confidence: 99%

“…As in other specialties, prescribing in dentistry has been declining over time 45 ; however, rates remain high. 46,47 and disposal, and daily dispensing and/or delayed prescriptions.…”

Section: Discussionmentioning

confidence: 99%

Quantifying unused opioids following emergency and ambulatory care: A systematic review and meta‐analysis

et al. 2022

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Objective To quantify unused opioids among adult and pediatric patients discharged from the emergency department (ED) or ambulatory care settings with a prescription for acute pain. Methods We searched MEDLINE, Embase, CINHAL, PsycINFO, the Cochrane Library, and the gray literature from inception to April 29, 2021. We included observational studies in which any patient with an acutely painful condition received a prescription for an opioid on discharge from an outpatient care setting, and unused opioids were quantified. Two reviewers screened records for eligibility, extracted data, and conducted the quality assessment. Where possible, we pooled data and otherwise described the results of studies narratively. Total unused prescriptions were synthesized using a weighted average. Random effects models were used, and heterogeneity was measured by the I 2 statistic. Our primary outcome was the quantity of unused opioid medication available after receiving a prescription for acute pain. Secondary outcomes were the proportion of patients with unused opioids following a prescription, the proportion of patients using no opioids, morphine equivalents of unused opioids, and factors associated with leftover opioids. Results In this systematic review and meta‐analysis of 9 studies in emergency and ambulatory care settings, 59.6% of prescribed opioids remained unused; pediatric patients had 69.3% of their prescriptions remaining, compared to 54.6% among adult patients. The highest proportion of unused opioids was found following dental extractions (82.6%). Conclusions and Relevance More than 50% of opioids remain unused following prescriptions for acute pain. Responsible prescribing must be accompanied by education on safer use, storage, and disposal.

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“…In more recent years of the study, we observed a decreased likelihood of filling higher quantities (i.e., ≥ 75th percentile) of opioid medications. This has also been observed in patients undergoing pediatric, 42 dental 43 and general surgical procedures 44 and may be a result of increasing provider awareness pertaining to the opioid crisis, 45 national efforts to address the crisis 46,47 and awareness of interventions to reduce prescribing. 48,49 Surgeons are interested in interventions that reduce prescribing, 50 and studies suggest that such interventions can be successfully implemented.…”

Section: Count Of Prescriptions Filledmentioning

confidence: 92%

Variation in opioid filling after same-day breast surgery in Ontario, Canada: a population-based cohort study

La¹,

Alqaydi²,

Wei³

et al. 2023

cmajo

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he rising use and misuse of opioids is a national and international crisis that contributes significantly to opioid-related deaths, particularly in young adults. 1,2 In Canada, between January 2016 and June 2019, there were more than 13 900 apparent opioid-related deaths and 17 000 opioid-related hospital admissions. 3 In Canada and the United States, physicians prescribe higher quantities of opioids than in other countries 4,5 and the amount prescribed is often greater than is needed, as evidenced by the large numbers of unused opioids. 6,7 This may lead to longterm use in opioid-naive patients, 8,9 misuse by others in the household 10,11 and diversion (i.e., transfer of a medication from a lawful to unlawful distribution or use). 12 Surgeons commonly prescribe opioid analgesics to treat acute postoperative pain. In the US, despite writing only 1.8% of all medication prescriptions, surgeons accounted for 9.8% of all opioid prescriptions. 13 Breast cancer is the most common cancer in women in Canada, occurring in 1 in 8 females, with 27 000 new cases in 2019. 14 Breast surgery is commonly used to treat benign and malignant conditions. Postoperative pain management practices in breast surgery are variable among surgeons in the US, 15,16 with high rates of opioid analgesic overprescription, 5 despite recent literature that suggests 5 days is the appropriate length of time that opioids should be prescribed for breast surgery, if prescribed at all. 17 A recent Canadian study showed that patients undergoing breast surgery can achieve adequate pain control with minimal to no postoperative opioids. 18 To better evaluate prescribing practices, the Ontario Ministry of Health and Long-Term Care mandated data collection on Variation in opioid filling after same-day breast surgery in Ontario, Canada: a population-based cohort study

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Trends in national opioid prescribing for dental procedures among patients enrolled in Medicaid

Cited by 11 publications

References 19 publications

De-Implementing Opioids for Dental Extractions (DIODE): a multi-clinic, cluster-randomized trial of clinical decision support strategies in dentistry

De-Implementing Opioids for Dental Extractions (DIODE): a multi-clinic, cluster-randomized trial of clinical decision support strategies in dentistry

Quantifying unused opioids following emergency and ambulatory care: A systematic review and meta‐analysis

Variation in opioid filling after same-day breast surgery in Ontario, Canada: a population-based cohort study

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