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The Dental Professional’s Role in the Opioid Crisis

Course Number: 560

Comparative Opioid Abuse Rates in the United States and Abroad

The Centers for Disease Control and Prevention (CDC) report that opioid prescription rates in the US have been declining from a high in 2012 of approximately 255 million prescriptions to approximately 153 million prescriptions written in 2019.49 This amounts to an average of 49.5 prescriptions for every 100 US adults.49 Additionally, while the vast majority of US providers have been found to follow CDC guidelines for prescribing narcotic medication, approximately 1% of prescribers are responsible for over half of the opioid doses prescribed and one-quarter of the opioid prescriptions written, a pattern that has remained stable for a decade.50 Further, US adults were seven times more likely to receive an opioid prescription after surgery as those in Sweden!51 And the average dose for individuals in the US was significantly higher than in other countries; the average initial postoperative dose in the US as measured in morphine milligram equivalent (MME) doses was 247 MME compared to those dispensed in Sweden (197 MME) or Canada (169 MME).51 Compared to their global counterparts, providers in the US prescribe opioids more frequently, at higher doses, and throughout more stages of post-operative and pain treatment—including as first-line treatment—than their international counterparts. Use of higher-potency opioids is markedly elevated in the US compared with other countries, despite the fact that nearly all published clinical guidelines discourage the use of high-potency opioids, and in fact opioids at all, as first-line non-cancer pain treatment.52

Several explanations for these differences in prescribing patterns may be at play. Pain perception and the attitudes of healthcare providers towards pain varies widely between cultures. Americans are more likely than their European or Asian counterparts to view pain as a malady rather than a natural consequence of aging or injury.53-56 Regulatory controls and healthcare provider oversight also differs greatly between countries. In the U.S. much of the regulation is performed at the state rather than the Federal level, which may afford more variation and less tight control.57,58 The United States and New Zealand are also the only countries that allow prescription drugs to be advertised on television, which may create a consumer-driven approach to prescribing patterns with patients requesting and, in many cases, receiving drugs that they have seen in advertisements.59 While opioid prescription advertisements are generally not seen on television, the 2016 Super Bowl featured an ad for a drug designed to combat opioid-induced constipation, which drew ire from Physicians for Responsible Opioid Prescribing and the White House.60 Finally, differences in how healthcare is delivered and reimbursed lead to differences in how patients are treated when they present with pain, a multifactorial symptom which can relieve many underlying ailments. The average primary care physician or healthcare provider in the U.S. spends around 15 minutes with each patient and covers an average of six topics in that time frame.61,62 This may not be enough time to fully assess a patients’ condition, underlying contributory factors, and may contribute to a less holistic approach to pain control.