Association of opioid prescriptions from dental clinicians for US adolescents and young adults with subsequent opioid use and abuse
Open accessAbstract
Importance: Through prescription writing, dental clinicians are a potential source of initial opioid exposure and subsequent abuse for adolescents and young adults. Objective: To examine the association between index dental opioid prescriptions from dental clinicians for opioid-naive adolescents and young adults in 2015 and new persistent use and subsequent diagnoses of abuse in this population. Design, Setting, and Participants: This retrospective cohort study examined outpatient opioid prescriptions for patients aged 16 to 25 years in the Optum Research Database in 2015. Prescriptions were linked by National Provider Identifier number to a clinician category. Exposures: Individuals were included in the index dental opioid (opioid-exposed) cohort if they filled an opioid prescription from a dental clinician in 2015, had continuous health plan coverage and no record of opioid prescriptions for 12 months before receiving the prescription, and had 12 months of health plan coverage after receiving the prescription. Two age- and sex-matched opioid-nonexposed control individuals were selected for each opioid-exposed individual and were assigned a corresponding phantom prescription date. Main Outcomes and Measures: Receipt of an opioid prescription within 90 to 365 days, a health care encounter diagnosis associated with opioid abuse within 365 days, and all-cause mortality within 365 days of the index opioid or phantom prescription date. Results: Among 754 002 individuals with continuous enrollment in 2015, 97 462 patients (12.9%) received 1 or more opioid prescriptions, of whom 29 791 (30.6%) received prescriptions supplied by a dental clinician. The opioid-exposed cohort included 14 888 participants (7882 women [52.9%], 11 273 white [75.7%], with mean [SD] age, 21.8 [2.4] years), and the randomly selected opioid-nonexposed cohort included 29 776 participants (15 764 women [52.9%], 20 078 [67.4%] white, with mean [SD] age, 21.8 [2.4] years). Among the 14 888 individuals in the index dental opioid cohort, 1021 (6.9%) received another opioid prescription 90 to 365 days later compared with 30 of 29 776 (0.1%) opioid-nonexposed controls (adjusted absolute risk difference, 6.8%; 95% CI, 6.3%-7.2%), and 866 opioid-exposed individuals (5.8%) experienced 1 or more subsequent health care encounters with an opioid abuse-related diagnosis compared with 115 opioid-nonexposed controls (0.4%) (adjusted absolute risk difference, 5.3%; 95% CI, 5.0%-5.7%). There was only 1 death in each cohort. Conclusions and Relevance: The findings suggest that a substantial proportion of adolescents and young adults are exposed to opioids through dental clinicians. Use of these prescriptions may be associated with an increased risk of subsequent opioid use and abuse.
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Adolescents and young adults filling or receiving an opioid prescription after a dental procedure may have an increased risk of developing long-term opioid use and overdose than those who did not fill or receive an opioid prescription.
“In addition, adolescents and young adults filling or receiving an opioid prescription after a dental procedure may have an increased risk of developing long-term opioid use and overdose than those who did not fill or receive an opioid prescription.”
From Evidence-based clinical practice guideline for the pharmacologic management of acute dental pain in adolescents, adults, and older adults (2024) · cites this paper as [10]
The Results and Discussion report more opioid prescriptions 90–365 days later and more diagnoses associated with opioid abuse or overdose among adolescents and young adults who filled a dental-clinician opioid prescription than among unexposed controls. However, the study identified exposure by the prescriber, not by a confirmed dental procedure, and did not report overdose risk separately from abuse-related diagnoses. (LLM, conf=0.86)
Experimental — accuracy not yet measuredAdolescents are at an especially increased risk of developing an opioid use disorder, even after a single exposure.
“Adolescents are at an especially increased risk of developing an opioid use disorder, even after a single exposure.”
From Evidence-based clinical practice guideline for the pharmacologic management of acute dental pain in adolescents, adults, and older adults (2024) · cites this paper as [10]
The Results report more subsequent opioid-abuse diagnoses among opioid-naive adolescents and young adults who filled a dental opioid prescription than among unexposed controls; among exposed patients, those aged 22–25 had lower odds of an abuse diagnosis than those aged 16–18. The study measured diagnoses associated with opioid abuse, not confirmed development of opioid use disorder, and it does not establish that a single exposure caused the outcome. (LLM, conf=0.86)
Experimental — accuracy not yet measuredRelying on opioids to manage acute dental pain can have unintended negative consequences.
“Relying on opioids to manage acute dental pain can have unintended negative consequences.”
From Evidence-based clinical practice guideline for the pharmacologic management of acute dental pain in adolescents, adults, and older adults (2024) · cites this paper as [10]
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- Authors
- Schroeder, A. R., Dehghan, M., Newman, T. B., Bentley, J. P., & Park, K. T.
- Affiliations
- Stanford Medicine (US)
- University of California, San Francisco (US)
- Corresponding author
- Schroeder, Alan R.
- Venue
- JAMA Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2019-02-01
- Volume
- 179
- Issue
- 2
- Pages
- 145
- ISSN
- 2168-6106 (ISSN-L)
- PMC
- PMC6439650
- OpenAlex
- W2902602941
- Cited by
- 216
- References
- 37
- Citations by year
- 2026: 11 · 2025: 19 · 2024: 20 · 2023: 20 · 2022: 35 · 2021: 39 · 2020: 30 · 2019: 41
- FWCI
- 26.18
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA Internal Medicine (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Keywords
- opioid prescribing, dental clinicians, adolescents, young adults, opioid use disorder, opioid abuse, opioid-naive patients, prescription drug misuse, all-cause mortality, opioid exposure, healthcare encounters, prescription drug monitoring programs, health insurance coverage
- MeSH terms
- Adolescent, Adult, Analgesics, Opioid, Attitude of Health Personnel, Dentist-Patient Relations, Female, General Practice, Dental, Humans, Male, Opioid-Related Disorders, Drug Prescriptions, United States, Cohort Studies, Databases, Factual, Practice Patterns, Dentists', Young Adult, Inappropriate Prescribing
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