Anesthesia Experts

Elevated Risk for Opioid Abuse from Dental Prescriptions in Teens and Young Adults

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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.

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.

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