Americans who have a tooth pulled or another painful dental procedure in the U.S. today are much less likely to take opioid painkillers than they were just a few years ago, a new study shows.
This is good news, since research shows that opioids are not necessary for most dental procedures.
But the COVID-19 pandemic appears to have thrown a wrench in efforts to reduce opioid use in dental care — and it won’t be until months later that dentists and oral surgeons begin providing routine care again after a hiatus in the spring of 2020.
The decline in opioid prescriptions filled by dental patients in the pre-pandemic years of 2016 to 2019 was much faster than the rate of decline from June 2020 to December 2022, the study found.
Overall, dental opioids among US patients of all ages declined 45% from 2016 to the end of 2022, according to newly published findings. PLoS One by a team from the University of Michigan Medical School and School of Dentistry.
But even in decline, 7.4 million dental patients of all ages filled opioid prescriptions in 2022.
Fortunately, opioid prescriptions for adolescents and young adults — who face particularly high opioid-related risks — continue to decline at a faster rate after the epidemic breaks in dental care, the study found. But for other groups, the decline rate slowed after June 2020.
In all, the researchers estimate, 6.1 million more dental opioid prescriptions would have been dispensed between June 2020 and December 2022 if pre-pandemic trends had continued.
And American dentists and oral surgeons were still prescribing opioids at the end of 2022 at four times the rate that British dentists were in 2016.
“These data suggest that the dental profession has made great strides in reducing opioid prescriptions, but also suggest that progress is slowing.”
Cao-Ping Chua, MD, PhD, senior author of the new study and assistant professor of pediatrics at UM
He worked with first author and former UM research assistant Jason Zhang, who is now at Northwestern University’s medical school.
“We know from research that most patients’ dental pain can be controlled with non-opioid medications, avoiding the risks of opioids,” said co-author Romesh Nalia, DDS, MHCM, professor and associate dean of the UM School of Clinical Affairs. dentistry “While it is reassuring that dental opioid prescribing is declining, the recent slowness of the decline suggests that the dental profession needs to redouble its efforts to reduce unnecessary opioid prescribing.”
The researchers could not determine the mechanism leading to each opioid prescription, nor could they determine the exact reason for the decline in dental opioid prescriptions during the epidemic. However, there are some potential culprits.
“One reason for the delay may be that dentists were more likely to prescribe opioids only when necessary because of concerns that patients could not easily follow up with their dentists during the pandemic,” Zhang said.
Determining the right size
Chua, Nalliah and their colleagues have studied dental opioid prescribing multiple times, and worked with the Michigan Opioid Prescribing Engagement Network (OPEN) to develop prescribing guidelines for dental and oral surgery care available at michigan-open.org/dentistry.
Reducing the number of opioids prescribed to dental patients, especially young people, is thought to reduce the risk of opioid abuse and diversion of pills to the patient as well as to other people.
Poisoning by family members, and interactions between opioids and other substances, including alcohol and prescription drugs, are other reasons to focus on non-opioid dental pain care.
But no study has examined trends in dental opioid prescribing using epidemic-era data.
Differences by provider type, insurance type and region
The new study is based on data from a company called IQVIA that tracks prescriptions dispensed at 92% of US pharmacies. The researchers excluded data from March to May 2020, when routine dental care in the United States temporarily stopped.
Studies have shown that epidemic-related changes in dental opioid prescribing have varied widely. For example, the rate of decline in opioid prescribing by oral and maxillofacial surgeons—who perform more complex procedures on people with advanced dental conditions—slowed to a lesser degree than that of general dentists and dental subspecialists during the epidemic.
For low-income patients covered by the Medicaid program, the number of dental opioid prescriptions between June 2020-December 2022 was 57% higher than predicted if pre-pandemic trends continued. For privately insured patients, this percentage was 30% higher than predicted.
The authors speculate that worsening access to dental care for Medicaid patients—who already have poor access to begin with—has increased the number of painful dental emergencies and the need for opioids.
People living in the southern United States will make up nearly 46% of all people with dental opioid prescriptions in 2022, more than any other region. But the researchers found that the decline in dental opioid prescribing for people in the Northeast slowed to a greater degree than other regions. This means that by the end of 2022, if pre-epidemic rates continue to decline, dental opioid prescribing will be 69% higher in the Northeast compared to 23.8% in the South.
In addition to Chua, Zhang and Nalia, study authors include OPEN co-directors Jennifer Walzy, MD, MPH, MS and Chad Brummett, MD. All except Zhang are members of the UM Institute for Health Care Policy and Innovation, and Brummett is co-director of the UM Opioid Research Institute.
Susan B. Chua of the Department of Pediatrics. Meister is a member of the Center for Child Health Evaluation and Research, which also provided some funding for the study.
The research was funded by the Benter Foundation and the Michigan Department of Health and Human Services.