Prescribing Patterns for Opioid Pain Relievers

While healthcare providers in the United States have decreased their opioid prescribing since its peak in 2010, the amount of opioids prescribed per person tripled between 1999 and 201557,58 and opioid prescribing patterns vary widely among states and regions.59 The number of opioid prescriptions per 1000 dental patients increased from 130.58 in 2010 to 147.44 in 2015.6 These prescriptions represent approximately 12% of all immediate-release opioid prescriptions.5 It has also been estimated that approximately two-thirds of opioid prescriptions written in dental offices were prescribed during/following surgical dental visits and approximately one-third during non-surgical visits, the majority of which were operative procedures.6

It was also noted that the largest increase in the number of prescriptions was seen in the 11-18 year-old age group, from 99.71 per 1000 patients in 2010 to 165.94 per 1000 patients in 2015.6 Furthermore, it is estimated that 61% of 14- to 17-year olds receive opioid prescriptions from dentists following extraction of third molars.13 This is particularly concerning given the body of literature that associates age of first exposure to opioids to an increased risk of nonmedical use, misuse, and substance abuse of opioids in patients.4 Among high school seniors, 36.9% of nonmedical users of prescription opioids used the drugs from their previous prescriptions and 27% of those prescriptions were written by dentists.4,60 Non-medical use of opioids in adolescents and young adults parallels the prescribing rates for these medications, with male non-medical users having higher peer-to-peer diversion rates and rates of non-pain relief (recreational) use.4 Younger adults (18-25 years) have higher rates of opioid misuse (8.1%) than older adults (2.0%), despite more opioid prescriptions being written for older individuals.61 This may indicate that younger people are more vulnerable to opioid misuse and additional care should be given to opioid prescribing in that group.