Overprescribing of opioids to adults by dentists in the U.S., 2011-2015
Open accessAbstract
INTRODUCTION: Dentists prescribe 1 in 10 opioid prescriptions in the U.S. When opioids are necessary, national guidelines recommend the prescription of low-dose opioids for a short duration. This study assesses the appropriate prescribing of opioids by dentists before guideline implementation. METHODS: The authors performed a cross-sectional analysis of a population-based sample of 542,958 U.S. commercial dental patient visits between 2011 and 2015 within the Truven Health MarketScan Research Databases (data analysis October 2018‒April 2019). Patients with recent hospitalization, active cancer treatment, or chronic pain conditions were excluded. Prescription opioids were ascertained using pharmacy claims data with standardized morphine equivalents and recorded days' supply. Appropriate prescribing was determined from the 2016 Centers for Disease Control and Prevention guidelines for pain management based on a recommended 3 days' supply of opioid medication and anticipated post-procedural pain. RESULTS: Twenty-nine percent of prescribed opioids exceeded the recommended morphine equivalents for appropriate management of acute pain. Approximately half (53%) exceeded the recommended days' supply. Patients aged 18-34 years, men, patients residing in the Southern U.S., and those receiving oxycodone were most likely to have opioids prescribed inappropriately. The proportion of opioids that exceed the recommended morphine equivalents increased over the study period, whereas opioids exceeding the recommended days' supply remained unchanged. CONCLUSIONS: Between 1 in 4 and 1 in 2 opioids prescribed to adult dental patients are overprescribed. Judicious opioid-prescribing interventions should be tailored to oral health conditions and dentists.
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Providers may continue to rely on opioids.
“providers may continue to rely on opioids.7,18,19”
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 [19]
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Cites
Longitudinal Data Analysis for Discrete and Continuous Outcomes
Zeger, S. L., & Liang, K. (1986) · Biometrics · doi:10.2307/2531248 · Cited by 7,730 · see citing works
CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016
Dowell, D., Haegerich, T. M., & Chou, R. (2016) · JAMA · doi:10.1001/jama.2016.1464 · Cited by 5,161 · see citing works
Multiple significance tests: the Bonferroni method
Bland, M., & Altman, D. G. (1995) · BMJ · doi:10.1136/bmj.310.6973.170 · Cited by 3,898 · see citing works
CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016
Dowell, D., Haegerich, T. M., & Chou, R. (2016) · MMWR. Recommendations and Reports · doi:10.15585/mmwr.rr6501e1 · Cited by 2,697 · see citing works
Warren, J. L., Klabunde, C. N., Schrag, D., Bach, P. B., & Riley, G. F. (2002) · PubMed · doi:10.1097/01.mlr.0000020942.47004.03 · Cited by 1,719 · see citing works
Characteristics of Opioid Prescriptions in 2009
Volkow, N. D. (2011) · JAMA · doi:10.1001/jama.2011.401 · Cited by 813 · see citing works
The Burden of Opioid-Related Mortality in the United States
Gomes, T., Tadrous, M., Mamdani, M., Paterson, J. M., & Juurlink, D. N. (2018) · JAMA Network Open · doi:10.1001/jamanetworkopen.2018.0217 · Cited by 641 · see citing works
Comparison of SEER Treatment Data With Medicare Claims
Noone, A., Lund, J. L., Mariotto, A. B., et al. (2014) · Medical Care · doi:10.1097/mlr.0000000000000073 · Cited by 488 · see citing works
Methods for identifying 30 chronic conditions: application to administrative data
Tonelli, M., Wiebe, N., Fortin, M., Guthrie, B., Hemmelgarn, B. R., James, M. T., Klarenbach, S. W., Lewanczuk, R., Manns, B. J., Ronksley, P., et al. (2016) · BMC Medical Informatics and Decision Making · doi:10.1186/s12911-015-0155-5 · Cited by 400 · see citing works
Reduction in Opioid Prescribing Through Evidence-Based Prescribing Guidelines
Howard, R., Waljee, J. F., Brummett, C. M., Englesbe, M. J., & Lee, J. S.-J. (2017) · JAMA Surgery · doi:10.1001/jamasurg.2017.4436 · Cited by 326 · see citing works
Antibiotic prophylaxis for dental patients with total joint replacements
(2003) · The Journal of the American Dental Association · doi:10.14219/jada.archive.2003.0289 · Cited by 261 · see citing works
Suda, K. J., Calip, G. S., Zhou, J., Rowan, S., Gross, A. E., Hershow, R. C., Perez, R. I., McGregor, J. C., & Evans, C. T. (2019) · JAMA Network Open · doi:10.1001/jamanetworkopen.2019.3909 · Cited by 217 · see citing works
Self-citationCombining ibuprofen and acetaminophen for acute pain management after third-molar extractions
Moore, P. A., & Hersh, E. V. (2013) · The Journal of the American Dental Association · doi:10.14219/jada.archive.2013.0207 · Cited by 215 · see citing works
Addressing the Opioid Epidemic in the United States
Gellad, W. F., Good, C. B., & Shulkin, D. J. (2017) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2017.0147 · Cited by 210 · see citing works
Self-citationMaughan, B. C., Hersh, E. V., Shofer, F. S., Wanner, K. J., Archer, E., Carrasco, L., & Rhodes, K. V. (2016) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2016.08.016 · Cited by 202 · see citing works
Tian, T., Zlateva, I., & Anderson, D. (2013) · Journal of the American Medical Informatics Association · doi:10.1136/amiajnl-2013-001856 · Cited by 163 · see citing works
Ringwalt, C., Gugelmann, H. M., Garrettson, M., Dasgupta, N., Chung, A. E., Proescholdbell, S., & Skinner, A. C. (2014) · Pain Research and Management · doi:10.1155/2014/857952 · Cited by 158 · see citing works
Persistent opioid use after wisdom tooth extraction
Harbaugh, C. M., Nalliah, R. P., Hu, H. M., Englesbe, M. J., Waljee, J. F., & Brummett, C. M. (2018) · JAMA · doi:10.1001/jama.2018.9023 · Cited by 153 · see citing works
Opioid prescription claims among women of reproductive age--United States, 2008-2012.
Ailes, E. C., Dawson, A. L., Lind, J. N., Gilboa, S. M., Frey, M. T., Broussard, C. S., & Honein, M. A. (2015) · PubMed Central · Cited by 140 · see citing works
Jones, C. M., Lurie, P. G., & Throckmorton, D. C. (2016) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2015.7799 · Cited by 124 · see citing works
Prevention of prescription opioid abuse
Denisco, R. C., Kenna, G. A., O’Neil, M. G., Kulich, R. J., Moore, P. A., Kane, W. T., Mehta, N. R., Hersh, E. V., & Katz, N. P. (2011) · The Journal of the American Dental Association · doi:10.14219/jada.archive.2011.0268 · Cited by 123 · see citing works
Nasseh, K., Vujicic, M., & Glick, M. (2017) · Health Economics · doi:10.1002/hec.3316 · Cited by 120 · see citing works
Comparison of Opioid Prescribing by Dentists in the United States and England
Suda, K. J., Durkin, M. J., Calip, G. S., Gellad, W. F., Kim, H., Lockhart, P. B., Rowan, S. A., & Thornhill, M. H. (2019) · JAMA Network Open · doi:10.1001/jamanetworkopen.2019.4303 · Cited by 103 · see citing works
Self-citationAizcorbe, A. M., Liebman, E. B., Pack, S., Cutler, D., Chernew, M. E., & Rosen, A. B. (2012) · Statistical Journal of the IAOS · doi:10.3233/sji-2012-0743 · Cited by 98 · see citing works
Potential misuse and inappropriate prescription practices involving opioid analgesics.
Liu, Y., Logan, J. E., Paulozzi, L. J., Zhang, K., & Jones, C. M. (2013) · PubMed · Cited by 91 · see citing works
Rasubala, L., Pernapati, L., Velasquez, X., Burk, J., & Ren, Y.-F. (2015) · PLoS ONE · doi:10.1371/journal.pone.0135957 · Cited by 91 · see citing works
Paulukonis, S. T., Eckman, J. R., Snyder, A., Hagar, W., Feuchtbaum, L., Zhou, M., Grant, A. M., & Hulihan, M. (2016) · Public Health Reports · doi:10.1177/003335491613100221 · Cited by 89 · see citing works
Daniels, S. E., Goulder, M. A., Aspley, S., & Reader, S. (2011) · Pain · doi:10.1016/j.pain.2010.12.012 · Cited by 87 · see citing works
Opioid prescribing practices from 2010 through 2015 among dentists in the United States
Gupta, N., Vujicic, M., & Blatz, A. (2018) · The Journal of the American Dental Association · doi:10.1016/j.adaj.2018.01.005 · Cited by 84 · see citing works
Mutlu, İ., Abubaker, A. O., & Laskin, D. M. (2013) · Journal of Oral and Maxillofacial Surgery · doi:10.1016/j.joms.2013.04.031 · Cited by 80 · see citing works
Opioid Prescribing After Surgical Extraction of Teeth in Medicaid Patients, 2000-2010
Baker, J. A., Avorn, J., Levin, R., & Bateman, B. T. (2016) · JAMA · doi:10.1001/jama.2015.19058 · Cited by 65 · see citing works
Gellad, W. F., Thorpe, J. M., Zhao, X., Thorpe, C. T., Sileanu, F. E., Cashy, J., Hale, J. A., Mor, M. K., Radomski, T. R., Hausmann, L. R. M., et al. (2017) · American Journal of Public Health · doi:10.2105/ajph.2017.304174 · Cited by 60 · see citing works
Self-citationPrescribing recommendations for the treatment of acute pain in dentistry.
Hersh, E. V., Kane, W. T., O’Neil, M. G., et al. (2011) · PubMed · Cited by 53 · see citing works
State-based surveillance for selected hemoglobinopathies
Hulihan, M., Feuchtbaum, L., Jordan, L. B., et al. (2014) · Genetics in Medicine · doi:10.1038/gim.2014.81 · Cited by 47 · see citing works
Dunn, A. C., Liebman, E. B., Pack, S., et al. (2012) · Health Services Research · doi:10.1111/1475-6773.12008 · Cited by 46 · see citing works
Opioid Analgesic Prescribing Practices of Dental Professionals in the United States
Steinmetz, C. N., Zheng, C., Okunseri, E., Szabó, A., & Okunseri, C. E. (2017) · JDR Clinical & Translational Research · doi:10.1177/2380084417693826 · Cited by 43 · see citing works
Opioid prescribing and risk mitigation implementation in the management of acute pain
McCauley, J. L., Leite, R. S., Gordan, V. V., Fillingim, R. B., Gilbert, G. H., Meyerowitz, C., Cochran, D. L., Rindal, D. B., & Brady, K. T. (2018) · The Journal of the American Dental Association · doi:10.1016/j.adaj.2017.11.031 · Cited by 32 · see citing works
The impact of pharmacy services on opioid prescribing in dental practice
Stewart-Lynch, A. L., Zborovancik, K. J., & Stiely, K. L. (2017) · Journal of the American Pharmacists Association · doi:10.1016/j.japh.2017.01.010 · Cited by 30 · see citing works
Multiple opioid prescriptions among privately insured dental patients in the United States
Gupta, N., Vujicic, M., & Blatz, A. (2018) · The Journal of the American Dental Association · doi:10.1016/j.adaj.2018.02.025 · Cited by 30 · see citing works
Variations in prescription drug monitoring program use by prescriber specialty
Sun, B., Lupulescu‐Mann, N., Charlesworth, C. J., Kim, H., Hartung, D. M., Deyo, R. A., & McConnell, K. J. (2018) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2018.08.006 · Cited by 20 · see citing works
Introducing the New BEA Health Care Satellite Account
Dunn, A. C., Rittmueller, L., & Whitmire, B. (2015) · Cited by 18 · see citing works
Opioid, NSAID, and OTC Analgesic Medications for Dental Procedures: PEARL Network Findings.
Wong, Y. J., Keenan, J., Hudson, K., et al. (2018) · PubMed · Cited by 17 · see citing works
Use of Nonpalliative Medications Following Burdensome Health Care Transitions in Hospice Patients
Zueger, P., Holmes, H. M., Qato, D. M., Pickard, A. S., Calip, G. S., & Lee, T. A. (2018) · Medical Care · doi:10.1097/mlr.0000000000001008 · Cited by 7 · see citing works
Self-citation
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Carrasco-Labra, A., Polk, D. E., Urquhart, O., Aghaloo, T., Claytor, J. W., Dhar, V., Dionne, R. A., Espinoza, L., Gordon, S. M., Hersh, E. V., et al. (2024) · The Journal of the American Dental Association · doi:10.1016/j.adaj.2023.10.009 · Cited by 62 · see citing works
“7,18,19 20–39 Although these documents and statements generally come to similar conclusions, clinicians may struggle to determine which guidance to follow as they are not all in complete alignment.”
BackgroundSelf-citationSerious opioid-related adverse outcomes associated with opioids prescribed by dentists
Khouja, T., Zhou, J., Gellad, W. F., Mitsantisuk, K., Hubbard, C. C., Yan, C. H., Sharp, L. K., Calip, G. S., Evans, C. T., & Suda, K. J. (2022) · Pain · doi:10.1097/j.pain.0000000000002545 · Cited by 21 · see citing works
Self-citationDistribution of opioid prescribing and high-risk prescribing among U.S. dentists in 2019
Chua, K.-P., Waljee, J. F., Gunaseelan, V., Nalliah, R. P., & Brummett, C. M. (2022) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2021.09.017 · Cited by 19 · see citing works
Dental opioid prescriptions and overdose risk in patients and their families
Chua, K.-P., Kenney, B. C., Waljee, J. F., Brummett, C. M., & Nalliah, R. P. (2021) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2021.02.008 · Cited by 16 · see citing works
- Authors
- Suda, K. J., Zhou, J., Rowan, S. A., McGregor, J. C., Perez, R. I., Evans, C. T., Gellad, W. F., & Calip, G. S.
- Affiliations
- University of Pittsburgh (US)
- University of Illinois Chicago (US)
- Oregon State University (US)
- Northwestern University (US)
- Corresponding author
- Suda, Katie J.
- ORCID
- Venue
- American Journal of Preventive Medicine
- Publisher
- Elsevier BV
- Published
- 2020-04
- Volume
- 58
- Issue
- 4
- Pages
- 473-486
- ISSN
- 0749-3797 (ISSN-L)
- PMC
- PMC8370654
- OpenAlex
- W3005324253
- Cited by
- 55
- References
- 44
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 2 · 2023: 11 · 2022: 17 · 2021: 13 · 2020: 3
- FWCI
- 8.23
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- American Journal of Preventive Medicine (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion, cc-by-nc-nd)
- Funders
- Agency for Healthcare Research and Quality
- Topics
- 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
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Keywords
- opioid overprescribing, dental prescribing, prescription opioids, morphine milligram equivalents, days' supply, post-procedural pain, CDC opioid prescribing guidelines, oxycodone, opioid prescribing guidelines
- MeSH terms
- Prescription Drug Monitoring Programs, Adolescent, Adult, Aged, Analgesics, Opioid, Cross-Sectional Studies, Dentists, Female, Humans, Male, Middle Aged, Practice Patterns, Physicians', United States, Multivariate Analysis, Young Adult, Inappropriate Prescribing, Pain Management
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