Opioid Prescribing Patterns In Oral Health Care

A new study has made headlines by illuminating the large difference in opioid prescribing patterns among U.S. dentists and their British counterparts. Although researchers found the oral health of American and English patients to be similar, U.S. dentists wrote 37 times as many opioid pain-relief prescriptions in 2016 as English dentists — 1.4 million versus 28,000. On a per dentist basis, the average U.S. clinician wrote 58.2 opioid prescriptions in 2016, compared to just 1.2 prescriptions per English dentist.¹

Although health care professionals are under scrutiny to be more discerning in their pain management strategies, when one looks at the number of opioid prescriptions per U.S. pro­vider on an annual basis, medical professionals far surpass dentists, who still rank among the top opioid prescribers. Compared to the average of 58.2 prescriptions per dentist, pain medicine physicians dispense 1314.9 opioid prescriptions, while physical medicine and rehabilitation specialists write 1023.1 each year.²

The study also shows what types of opioid medications U.S. dentists are prescribing. Due to Britain’s single-payer National Health Services, English dentists only prescribe codeine for their patients. By comparison, U.S. dentists — who have a mix of payers, as well as self-pay patients — have a much broader choice in what they can dispense. By far, the most popular opioid among U.S. dentists is hydro­codone,¹ which is more powerful than codeine. However, in light of the opioid abuse crisis — an estimated 130 Americans died every day from opioid overdoses in 2017³ — it is concerning that 9% of dental prescriptions are for oxycodone,¹ the synthetic opioid heavily linked to the epidemic.

Given this discrepancy in prescribing patterns between dentists on each side of the pond, it behooves oral health professionals to continue to rethink their pain management paradigm.

REFERENCES

1. Suda KJ, Durkin MJ, Calip GS, et. al. Comparison of opioid prescribing by dentists in the United States and England. JAMA Netw Open. 2019;2:e194303.
2. Guy GP, Zhang K. Opioid prescribing by specialty and volume in the U.S. Am J Prev Med. 2018;55:e153–e155.
3. U.S Centers for Disease Control and Prevention. Wide-ranging online data for epidemiologic research (WONDER). Available at: http:/​/​wonder.cdc.gov. Accessed June 18, 2019.

From Decisions in Dentistry. July/August 2019;5(7):60.