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Cited by 6Pharmaceutical Practices and Patient OutcomesOpioid Use Disorder TreatmentPain Management and Opioid Use

Potentially Inappropriate Medication Combination with Opioids among Older Dental Patients: A Retrospective Review of Insurance Claims Data

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Zhou, Jifang, Calip, Gregory S., Rowan, Susan, McGregor, Jessina C., Perez, Rosanne I., Evans, Charlesnika T., Gellad, Walid F., Suda, Katie J.·2020·Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy
DOI 10.1002/phar.2452PMC PMC8483014
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Abstract

Background: Opioid prescribing by dentists for older patients receiving medications with potential contraindications and the subsequent impact on acute care outcomes is not well described. Objectives: Our objective of this paper was to evaluate the use of potentially inappropriate medication combinations (PIMCs) involving opioids prescribed by dentists according to the Beers Criteria and risks of 30‐day emergency department (ED) visits and all‐cause hospitalization among commercially insured dental patients ages 65 years and older. Methods: We conducted a retrospective cohort study of 40,800 older dental patient visits in which opioids were prescribed between 2011 and 2015 using the IBM MarketScan databases. Data collection from dental, medical, and pharmacy claims included information on the concurrent use of PIMCs and outcomes of all‐cause acute care utilization over the 30‐day period after dental encounters. Results: For the overall cohort, the median age was 69 years, and 45% were women. The prevalence of PIMCs per Beers Criteria was 10.4%. A total of 947 all‐cause acute care events were observed in the 30 days post‐dental visit. Patients with PIMCs involving opioids prescribed by dentists according to the Beers Criteria had higher rates of acute care use (3.3% vs 2.2%, p<0.001), which were associated with an increased risk of all‐cause acute care utilization (adjusted risk ratio [RR] 1.23, 95% confidence interval [CI] 1.02–1.48). A dose‐response relationship was seen with increasing oral morphine equivalents prescribed and increased acute care utilization (p<0.001). Conclusion: A significant proportion of older patients receiving opioids at dental visits use psychotropic medications that in combination should be avoided according to the American Geriatric Society Beers Criteria.

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  • Adding tramadol to SSRIs can precipitate serotonin syndrome.

    “adding tramadol (an opioid) to SSRIs can precipitate serotonin syndrome [11,12].”

    From Comparing Artificial Intelligence (ChatGPT, Gemini, DeepSeek) and Oral Surgeons in Detecting Clinically Relevant Drug–Drug Interactions in Dental Therapy (2025) · cites this paper as [11]

    The Introduction (page unavailable) lists SSRIs and opioids as CNS-active drug classes of concern, and a table indexed as REFERENCES records tramadol prescriptions. Neither passage addresses serotonin syndrome or says that combining tramadol with SSRIs can precipitate it. Searches for “tramadol serotonin syndrome,” “serotonin syndrome,” and “tramadol” found no passage making that link. (LLM, conf=0.72)

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Authors
Zhou, J., Calip, G. S., Rowan, S., McGregor, J. C., Perez, R. I., Evans, C. T., Gellad, W. F., & Suda, K. J.
Affiliations
  • China Pharmaceutical University (CN)
  • University of Illinois Chicago (US)
  • Oregon State University (US)
  • Northwestern University (US)
  • University of Pittsburgh (US)
Corresponding author
Calip, Gregory S.
ORCID
Venue
Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy
Publisher
Wiley
Published
2020-09-02
Volume
40
Issue
10
Pages
992-1001
ISSN
  • 0277-0008 (ISSN-L)
  • 1875-9114
DOI
10.1002/phar.2452
PMC
PMC8483014
OpenAlex
W3047930319
Cited by
6
References
1
Citations by year
2025: 1 · 2023: 2 · 2022: 2 · 2021: 1
FWCI
0.66
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Pharmacotherapy The Journal of Human Pharmacology and Drug Therapy (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
Agency for Healthcare Research and Quality (R01HS25177)
Topics
  • Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
Keywords
opioids, older adults, dental prescribing, Beers criteria, psychotropic drugs, emergency department visits, hospitalization, oral morphine equivalents, acute care utilization, drug-drug interactions
MeSH terms
Potentially Inappropriate Medication List, Aged, Aged, 80 and over, Analgesics, Opioid, Dentistry, Female, Health Services for the Aged, Humans, Insurance Claim Review, Male, Practice Patterns, Physicians', Retrospective Studies, United States, Cohort Studies

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