U.S. Surgeon General Vivek Murthy has launched a campaign to address an epidemic of opioid addiction that holds two million Americans in its grip. His drive not only focuses upon getting people who are already addicted into treatment, but upon preventing new cases of addiction by appealing to health care professionals – including the nation’s dentists – to consider alternatives when helping patients manage pain.
Addiction can begin with a routine prescription, Murthy has stressed.
Oral health providers have good reasons to examine prescribing practices with an eye toward the dangers of addiction, a research team at Boston’s Brigham and Women’s Hospital and Harvard Medical School recently concluded.
Dentists are among the leading prescribers of opioid pain medications, according to the team’s research letter, just published online by the Journal of the American Medical Association. The prescriptions often are written for patients who have undergone surgical tooth extractions. But the authors raise questions about the common practice of treating post-extraction pain with opioids.
“Surveys suggest that dental practitioners commonly prescribe opioids following this procedure, despite evidence that a combination of nonsteroidal medications and acetaminophen may provide more effective analgesia for post-extraction pain,” they wrote.
For their study, the researchers looked at a cohort of more than 2.75 million Medicaid patients around the country who underwent extractions between 2000 and 2010. They found that within seven days of undergoing the procedure, more than 1.16 million, or 42 percent, of them filled a prescription for an opioid medication.
The most commonly dispensed medication was hydrocodone (78 percent of all prescriptions), followed by oxycodone (15.4 percent.)
The highest proportions of the prescriptions were filled for teens and young adults, ranging in age from 14 to 24 years old.
The median amount of medication dispensed to adults following extractions amounted to 24 5-milligram tablets of hydrocodone or 16 5-milligram tablets of oxycodone, the study said
The researchers acknowledged their conclusions, which were based upon a cohort of Medicaid patients, might not always apply to privately insured patients. They also noted that dental prescribing practices may have changed since 2010, the final year of the study. A study published last year in the American Journal of Preventive Medicine, which looked at prescribing patterns across medical specialties, suggested some dentists might be getting the message. It found that the prescribing of opioids by dentists had decreased by 5.7 percent between 2007 and 2012.
The Boston researchers ended their JAMA letter with words of caution:
“Although a limited supply of opioids may be required for some patients following tooth extraction, these data suggest that disproportionately large amounts of opioids are frequently prescribed. … “As the nation implements programs to reduce excessive prescribing of opioid medications, it will be important to include dental care in these approaches.”