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• Posted November 10, 2023

Americans Are Now Getting Far Fewer Opioids for Dental Pain

If you're getting a tooth pulled or having another painful dental procedure, you're much less likely to get opioids than you were just a few years ago, new research reveals.

That's good news because opioid abuse is a major issue in the United States and these drugs aren't necessary for most dental procedures.

But there was a bit of bad news in the findings: Efforts to reduce opioid use in dental care did hit a snag during the pandemic, according to the study authors.

The decline in opioid prescriptions filled by dental patients was much faster in the pre-pandemic years 2016 through 2019, compared with the rate of decline from June 2020 to December 2022.

"These data suggest the dental profession has made major strides in reducing opioid prescribing, but also suggest that progress is slowing,"said senior study author Dr. Kao-Ping Chua, an assistant professor of pediatrics at the University of Michigan (UM) Medical School.

Dental opioids dispensed to U.S. patients of all ages declined 45% from 2016 to the end of 2022. Still, about 7.4 million dental patients filled opioid prescriptions in 2022.

Those prescriptions for teens and young adults, at especially high risk related to opioids, did keep declining rapidly even after the early pandemic pause. For other groups, the rate of decline slowed after June 2020.

If the pace of decline had continued, 6.1 million fewer dental opioid prescriptions would have been dispensed between June 2020 and December 2022.

American dentists and oral surgeons were still prescribing opioids in late 2022 at four times the rate that another study showed British dentists were prescribing in 2016, according to researchers.

"We know from research that dental pain in most patients can be controlled with non-opioid medications, avoiding the risks of opioids,"study co-author Dr. Romesh Nalliah, associate dean for clinical affairs at the UM School of Dentistry, said in a university news release. "While it's reassuring that dental opioid prescribing is declining, the recent slowing in the decline suggests the dental profession must redouble its efforts to reduce unnecessary opioid prescribing."

It's possible the reason for the slowing of the decline was that dentists may have been more likely to prescribe opioids just in case they were necessary, out of concern that patients couldn't easily follow up with their dentist during the pandemic, Zhang suggested.

For this study, researchers used data from a company called IQVIA that tracks prescriptions dispensed at 92% of U.S. pharmacies. The researchers excluded data from March through May of 2020, during a pandemic pause in routine dental care.

Pandemic-associated changes in dental opioid prescribing varied widely. The rate of decline in opioid prescribing by oral and maxillofacial surgeons, who perform more complex procedures on people with advanced dental conditions, slowed during the pandemic to a lesser degree than for general dentists and dental sub-specialists, the study found.

The number of dental opioid prescriptions from June 2020 to December 2022 was 57% higher than predicted for low-income patients covered by Medicaid. For privately insured patients, this percentage was 30% higher than predicted.

Worsened access to dental care in Medicaid patients may have increased the number of painful dental emergencies and the need for opioids, the authors theorized.

Nearly 56% of dental opioid prescriptions in 2022 went to people living in the Southern United States, while the decline in dental opioid prescribing to people in the Northeast slowed to a greater degree than in other regions.

By late 2022, dental opioid prescribing was 69% higher in the Northeast than it would have been if declines had continued at pre-pandemic rates, compared with 23.8% in the South.

The study, published Nov. 2 in the journal PLOS One, was funded by the Benter Foundation and the Michigan Department of Health and Human Services.

More information

The U.S. Centers for Disease Control and Prevention has more on the opioid epidemic.

SOURCE: Michigan Medicine -- University of Michigan, news release, Nov. 2, 2023