Americans who have had a tooth pulled or other painful dental surgery in the United States today are far less likely to take opioid painkillers than they were a few years ago, a new study shows.
This is good news, as research shows that opioids are not necessary for most dental procedures.
But the COVID-19 pandemic appears to have thrown a wrench in the effort to reduce opioid use in dental care — and not just months after dentists and oral surgeons began providing routine care again after a spring 2020 hiatus.
The decline in opioid prescriptions paid for by dental patients was much faster in the pre-pandemic years 2016 to 2019, compared to the rate of decline from June 2020 to December 2022, the study shows.
Overall, dental opioids prescribed to patients of all ages in the US fell by 45% from 2016 to the end of 2022, according to new findings published in PLoS One by a team from the University of Michigan School of Medicine and School of Dentistry.
However, even with the decline, 7.4 million dental patients of all ages filled opioid prescriptions in 2022.
Fortunately, opioid prescriptions among teenagers and young adults — who face particularly high opioid-related risks — continued to decline at a rapid pace after the pandemic halt in dental care, the study finds. But for other groups, the rate of decline slowed after June 2020.
Overall, the researchers estimate, 6.1 million more dental opioid prescriptions were filled from June 2020 to December 2022 than would have been the case 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 another study of British dentists showed in 2016.
“These data suggest that the dental profession has made significant strides in reducing opioid prescribing, but they also suggest that progress is slowing,” said Kao-Ping Chua, MD, Ph.D., the 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 in medical school at Northwestern University.
“We know from research that dental pain in most patients can be controlled with non-opioid medications, avoiding the risks of opioids,” said co-author Romesh Nalliah, DDS, MHCM, professor and associate dean for clinical affairs at the UM School of Dentistry. “While it is reassuring that opioid prescribing for dentists is declining, the recent slowdown in the decline suggests that the dental profession must redouble its efforts to reduce unnecessary opioid prescribing.”
The researchers were unable to identify the process that led to each opioid prescription, nor could they determine the exact reason for the slow decline in opioid prescribing during the pandemic. However, there are some potential culprits.
“One reason for the slowdown may be that dentists were more likely to prescribe opioids only if they were necessary, due to concerns that patients could not easily follow up with their dentist during the pandemic,” Zhang said.
Right Size Prescription
Chua, Nalliah, and colleagues have studied dental opioid prescribing multiple times and collaborated with the Michigan Opioid Prescribing Engagement Network (OPEN) to develop prescribing guidelines for dental and oral surgical care (available at https://michigan-open.org/dentistry/).
Reducing the number of opioids given to dental patients, particularly young people, is believed to reduce the risk of opioid abuse and diversion of pills to people other than the patient.
Poisoning of others in the household and interactions between opioids and other substances, including alcohol and prescription drugs, are other reasons to focus on opioid-free dental pain care.
However, no study has examined opioid prescribing trends for teeth using data from the pandemic era.
Differences by provider type, insurance type and region
The new study is based on data from a company called IQVIA that tracks prescriptions filled at 92 percent of U.S. pharmacies. The researchers excluded data from March to May 2020, when routine dental care in the US was temporarily halted.
The study revealed that pandemic-related changes in dental opioid prescribing 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 disease—slowed during the pandemic to a lesser extent than for general dentists and subspecialists.
For low-income Medicaid patients, the number of dental opioid prescriptions in June 2020-December 2022 was 57% higher than predicted than if pre-pandemic trends had continued. For patients with private insurance, this rate was 30% higher than predicted.
The authors hypothesized that deteriorating access to dental care for Medicaid patients — who already have poor access to begin with — may have increased the number of painful dental emergencies and the need for opioids.
People living in the southern US accounted for nearly 46% of all people with dental opioid prescriptions in 2022, higher than any other region. However, the researchers found that the decline in opioid prescriptions among people in the Northeast slowed to a greater extent than in other regions. That meant that by the end of 2022, opioid prescribing for dental products was 69% higher in the Northeast than it would have been if the decline had continued at pre-pandemic rates, compared with 23.8% in the South.
In addition to Chua, Zhang, and Nalliah, study authors include OPEN co-directors Jennifer Waljee, MD, MPH, MS, and Chad Brummett, MD. All but Zhang are members of the UM Institute for Health Policy and Innovation, and the Brummett co-directs the UM Opioid Research Institute.
Chua is a member of the Susan B. Meister Center for Child Health Evaluation and Research in the Department of Pediatrics, which also provided part of the funding for the study.
The study was also funded by the Benter Foundation and the Michigan Department of Health and Human Services.