Dental opioid prescriptions and overdose risk in patients and their families
Open accessAbstract
Introduction It is unknown whether dental opioid prescriptions are associated with opioid overdose in patients or their family members, who may have access to patients' opioids.Methods During July-October 2020, the 2011-2018 IBM MarketScan Dental, IBM MarketScan Commercial, and Medicaid Multi-State Databases were analyzed. Two analyses were conducted. In the patient analysis, dental procedures for privately and publicly insured patients aged 13-64 years were identified. The exposure was ≥1 initial prescription (dispensed opioid prescription within 3 days of the procedure). The association between the exposure and ≥1 overdose within 90 days of the procedure was evaluated using logistic regression. In the family analysis, procedures for privately insured patients in family plans were identified. The association between the exposure and ≥1 overdose in a family member within 90 days was evaluated using logistic regression. In both analyses, the average marginal effect of the exposure was calculated, representing the change in the probability of the outcome if all versus if no procedures were associated with ≥1 initial prescription.Results The patient analysis included 8,544,098 procedures. When ≥1 initial prescription did and did not occur, the 90-day risk of overdose was 5.8 versus 2.2 per 10,000 procedures (average marginal effect=1.5, 95% CI=1.2, 1.8). The family analysis included 3,461,469 procedures. When ≥1 initial prescription did and did not occur, the 90-day risk of overdose in a family member was 1.7 versus 1.0 per 10,000 procedures (average marginal effect=0.4, 95% CI=0.1, 0.7).Conclusions Findings further highlight the importance of avoiding unnecessary dental opioid prescribing.
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Risk of bias was assessed using the Cochrane risk of bias tool 2.0 for RCTs and the Risk Of Bias In Non-Randomized Studies-of Interventions tool for observational studies.
“using the Cochrane risk of bias tool 2.0 for RCTs45 and the Risk Of Bias In Non-Randomized Studies-of Interventions tool for observational studies46”
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 [46]
The Methods sections describe logistic regression and sensitivity analyses of dental opioid prescriptions, not a risk-of-bias assessment. Searches for ROBINS-I and the Cochrane risk of bias tool 2.0 found no passage addressing either tool; our copy therefore does not substantiate the use attributed to this citation. (LLM, conf=0.77)
Experimental — accuracy not yet measuredStudy selection, data extraction, and risk of bias assessment were conducted independently and in duplicate.
“conducted study selection, data extraction, and risk of bias assessment (using the Cochrane risk of bias tool 2.0 for RCTs45 and the Risk Of Bias In Non-Randomized Studies-of Interventions tool for observational studies46) independently and in duplicate.”
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 [46]
The Methods (Study Sample and Statistical Analysis; page not available) describe analyses of insurance-claims databases, not selection and assessment of published studies. Searches for duplicate study selection, data extraction, and Cochrane or ROBINS-I risk-of-bias assessment found no passage addressing those procedures. (LLM, conf=0.75)
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Self-citation
- Authors
- Chua, K.-P., Kenney, B. C., Waljee, J. F., Brummett, C. M., & Nalliah, R. P.
- Affiliations
- University of Michigan (US)
- Corresponding author
- Chua, Kao-Ping
- Venue
- American Journal of Preventive Medicine
- Publisher
- Elsevier BV
- Published
- 2021-08
- Volume
- 61
- Issue
- 2
- Pages
- 165-173
- ISSN
- 0749-3797 (ISSN-L)
- PMC
- PMC8319034
- OpenAlex
- W3158686413
- Cited by
- 16
- References
- 18
- Citations by year
- 2026: 4 · 2024: 1 · 2023: 5 · 2022: 4 · 2021: 2
- FWCI
- 2.59
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Preventive Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Drug Abuse
- 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 › Epidemiology › Substance Abuse Treatment and Outcomes
- Keywords
- opioid overdose, opioid prescribing, dental treatment, family members, overdose risk, opioid misuse prevention, dental insurance, Medicaid
- MeSH terms
- Analgesics, Opioid, Humans, Medicaid, Practice Patterns, Physicians', Drug Prescriptions, Retrospective Studies, United States, Prescriptions, Drug Overdose
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