Dental Procedure-Related Opioid Exposure and Later Risk for Opioid Abuse

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Patients included in the study had a filled opioid prescription from a dental clinic visit in 2015.
Patients included in the study had a filled opioid prescription from a dental clinic visit in 2015.

A substantial proportion of adolescent and young adults receiving opioids for dental procedures may be at higher risk for later opioid use and abuse, according to a study published in JAMA Internal Medicine.

The Optum Research Database was reviewed retrospectively to collect outpatient opioid prescription data for individuals ages 16 to 25 years. Patients included in the study had a filled opioid prescription from a dental clinic visit in 2015, continuous health plan coverage, including in the 12 months following receipt of the prescription, and no opioid prescription fills in the 12 months preceding the dental clinic opioid prescription. For each opioid-exposed individual, 2 age- and sex-matched opioid nonexposed control individuals were included in the study. The study's main outcomes were the receipt of an opioid prescription within 3 months to 1 year, all-cause mortality, or an opioid abuse diagnosis within 1 year of the index date of opioid or phantom prescription.

Of the 754,002 individuals in the Optum Research Database with continuous healthcare enrollment in 2015, 97,462 (13%) received ≥1 opioid prescription during 2015; 29,791 of these (30.6%) received their opioid prescription from a dental clinician. A total of 14,888 and 29,776 individuals included in the study were and were not exposed to opioids, respectively.

Of the 14,888 individuals in the index dental opioid cohort 1021 (6.9%) received another opioid analgesic prescription between 90 and 365 days later vs 30 of the 29,776 individuals (0.1%) who had not been exposed to opioids (adjusted absolute risk difference, 6.8%; 95% CI, 6.3%-7.2%; P <.001). Additionally, a higher percentage of opioid-exposed vs opioid-naive individuals had ≥1 subsequent healthcare exposure with an opioid abuse-related diagnosis (5.8% vs 0.4%, respectively; adjusted absolute risk difference, 5.3%; 95% CI, 5.0%-5.7%).

The sole reliance on International Classification for Diseases, 9th and 10th edition diagnosis codes for identifying opioid abuse represent a potential study limitation.

“Given the potential contribution of third molar extractions to the opioid epidemic, heightened scrutiny regarding this procedure and opioid prescriptions associated with postoperative care is warranted,” noted the study authors.

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Reference

Schroeder AR, Dehghan M, Newman TB, Bentley JP, Park KT. Association of opioid prescriptions from dental clinicians for US adolescents and young adults with subsequent opioid use and abuse [published online December 3, 2018]. JAMA Intern Med. doi: 10.1001/jamainternmed.2018.5419

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