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Authors: Schroeder AR et al.
JAMA Intern Med 2018 Dec 3
Dental procedures are a common source of first-time opioid exposure that can lead to further use and abuse.
Dental clinicians are a leading prescriber of opioids to children, often within the context of third molar extractions. Among generally healthy U.S. individuals aged 16 to 25 years enrolled in a private insurance plan, 30% of opioid prescriptions originated from dental clinicians. Using the same dataset, investigators further assessed the risk for continued opioid use and treatment for opioid abuse among nearly 15,000 patients who filled a dental opioid prescription compared with nearly 30,000 matched non–opioid-exposed controls. Results were as follows:
- Receipt of a second opioid prescription 90 to 365 days following the initial prescription occurred in 6.9% of the opioid prescription recipients compared with 0.1% of non–opioid-exposed controls.
- Dental prescriptions accounted for 27% of second opioid prescriptions.
- Within one year after the initial prescription, at least one health visit for opioid abuse occurred in 5.8% of opioid-exposed individuals compared with 0.4% of non–opioid-exposed controls.
- Being female and younger (aged 16–18 years vs. aged 22–25) were independently associated with increased likelihoods of continued opioid use and abuse.
- Asian patients had reduced risks for persistent opioid use and abuse compared with other racial groups.
- The number of pills prescribed (>20 vs. ≤20) was not associated with risk for persistent use or abuse.
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COMMENT
Although these data are focused on dental prescriptions, the observed associations with continued opioid use and abuse should be considered in any setting where a teen or young adult is given an opioid prescription. When we see our adolescent and older patients, we should inquire about planned dental procedures and recommend nonopioid pain management.