Prescription opiate use and the Dental Setting

Nonmedical use of prescription opioid medications is a widespread public health challenge. Dental practices are an important yet under-studied setting for understanding the problem of opioid misuse. Dentists are second only to family physicians as prescribers of opioid medications, prescribing an estimated 12% of immediate-release opioids in the U.S.  Because dental care routinely involves managing and treating pain or emergencies, dentists are potential targets for drug-seeking patients. Poor management of pain medications also increases the risk of opioid use disorders among patients who truly require such medications. 

We analyze prescription-level data from the IMS Health LifeLink™ LRx Longitudinal database in eleven states to examine the role of dentists in one particular pattern of behavior associated with problematic opioid use: "Provider shopping." In particular, we identified every patient who received opioid prescriptions from (1) at least five different providers (dentists, doctors, or others), and (2) filled these prescriptions in at least five different pharmacies within six months during 2012. 

Following this method, we identified 165,430 unique “provider-shoppers”, who filled 3,981,018 unique opioid prescriptions, an estimated prevalence similar to those found by other researchers. 3.8% of these opioids were prescribed by dentists. Almost one-third (31.9%) of identified provider-shopping patients received at least one opioid prescription from a dentist.

Most “provider-shoppers” filled only one or two dental opioid prescriptions, or none at all. Although most “provider-shoppers” received opioid prescriptions from only one dentist, 1,299 received prescriptions from at least five dentists. We identified 42,420 unique dentists who provided at least one opioid prescription to a “provider-shopping” patient. Most dentists prescribed to only one such patient. Yet, 3,093 dentists provided prescription opioids to five or more. 591 dentists prescribed opioids to ten or more “provider-shopping” patients.

Our analysis underscores the importance of dentists in problematic forms of prescription opiate use. Policy implications are discussed.