CDA Essentials 2017 • Volume 4 • Issue 7

21 Issue 7 | 2017 | I ssues and P eople Dentists’ Prescribing Practices in the United States • In Canada, little is known about dental prescribing practices for opioids, but data from the U.S. sheds some light on the issue. Researchers looked at two years of prescription monitoring program data for patients in South Carolina who were prescribed at least one opioid by a dentist. 3 Their goal was to better understand dentists’ prescribing patterns, the type and frequency of opioid prescriptions by dentists, and incidents of concurrent opioid prescriptions. • Dentists were a minority of unique prescribers (8.9%) but prescribed a substantial proportion (44.9%) of prescription opioids. • Almost all dispensed dentist-prescribed opioid prescriptions (99.9%; n = 653,650) were for immediate-release opioids and were initial prescription fills (96.2%). • Hydrocodone (76.1%) and oxycodone (12.2%) combination products were the most frequently dispensed opioids prescribed by dentists. • Dentists prescribed an average of more than 150 opioid prescriptions per year, per dentist. • Adolescents (younger than 21 years) accounted for 12.5% of all patients receiving opioids from dental prescriptions. • It was common for dental patients to have received additional opioid prescriptions from nondental care providers. Of all dental opioid- prescribing incidents, dentists wrote prescriptions to patients who had pre-existing opioids dispensed within the past 30 days in 20.9% of incidents, in 28.8% of incidents within the past 90 days, and in 34.7% of incidents within the past 180 days. “Consistent with best practice recommendations, opioids should be reserved for only a minority of cases of moderate to severe postoperative pain in which all other management options have been exhausted.” – McCauley et al. (2016) References 1. Gladstone EJ, Smolina K, Morgan SG. Trends and sex differences in prescription opioid deaths in British Columbia, Canada. InjPrev. 2016;22(4):288-90. 2. Chen Q, Chen J, Hu B, Feng G, Song J. Submucosal injection of dexamethasone reduces postoperative discomfort after third-molar extraction: A systematic review and meta-analysis. JAmDentAssoc. 2017;148(2):81-91. 3. McCauley JL, Hyer JM, Ramakrishnan VR, Leite R, Melvin CL, et al. Dental opioid prescribing and multiple opioid prescriptions among dental patients: Administrative data from the South Carolina prescription drug monitoring program. JAmDentAssoc. 2016;147(7):537-44. 4. Denisco RC, Kenna GA, O’Neil MG, Kulich RJ, Moore PA, et al. Prevention of prescription opioid abuse: the role of the dentist. J Am Dent Assoc. 2011;142(7):800-10. Teens, Wisdom Teeth and Opioids After third molar surgery, how many teens and young adults in the U.S. are prescribed opioids by oral and maxillofacial surgeons?  4 A survey of 563 oral and maxillofacial surgeons (OMFS) in the U.S found: • Most dentists (85%, n = 563) almost always prescribed a centrally acting opioid after performing third-molar extractions • 64% of opioid prescriptions were for hydrocodone with acetaminophen (brand names in the U.S. include Lorcet and Vicodin) • On average, OMFS prescribed 20 tablets of hydrocodone with acetaminophen, with instructions in 96% of cases to take “as needed for pain” “In our opinion, good clinical practice would suggest that prescribing quantities (of opioids) expected to last more than a few days actually may be harmful. Prolonged severe pain after surgery most often is an indication of poor healing or infection.” - Denisco et al. (2011)