U.S. dentists prescribe opioids far more often than British counterparts

(Reuters Health) - Dentists in the U.S. prescribe opioids at a rate 70 times higher than dentists in England, a new study finds.

Moreover, the types of opioids prescribed by U.S. dentists are more likely to be those “with a high potential for abuse, such as oxycodone,” researchers reported in JAMA Network Open.

“Dentists are one of the top prescribers of opioids, second only to family physicians” said lead study author Katie Suda, an associate professor of pharmacy at the University of Illinois, at Chicago, College of Pharmacy. “If you look at what prescription medications dentists are prescribing, opioids are the second most frequent, after antibiotics.”

Studies have shown that even as opioid prescribing rates have been declining overall, dental prescribing rates have been on the rise, Suda and her colleagues noted. And that’s despite the fact that there’s research proving that non-opioid analgesics are just as effective as opioids in controlling dental pain, Suda said.

“In our study, we found that one in 10 of the opioids (prescriptions from) U.S. dentists are for high potency opioids whereas dentists in England didn’t prescribe any of them,” Suda said. “The English model is very different. There are guidelines available that are specific about the treatment of oral pain. They recommend as the first line of therapy non-opioid analgesics: their version of acetaminophen and an NSAID.”

To take a closer look at the opioid prescribing patterns of U.S. dentists, Suda and her colleagues turned to two databases. Data for U.S. dentists came from IQVIA LRx, which contains data for 85 percent of all outpatient prescriptions and includes those written for patients covered by commercial insurers, Medicare and Medicaid. Data for English dentists came from the NHS Digital Prescription Cost Analysis and included 84 percent of the UK population.

In 2016, U.S. dentists wrote more than 11.4 million opioid prescriptions, while English dentists wrote 28,082 prescriptions for the drugs. The proportion of all dental prescriptions written for opioids was 37 times greater in the U.S. than in England.

Moreover, dentists in the U.S. wrote opioid prescriptions at a rate that was more than 70 times that of their English counterparts: U.S. dentists wrote 35.4 opioid prescriptions per 1,000 Americans, while English dentists wrote 0.5 opioid prescriptions per 1,000 British.

While there has been a lot of attention paid to opioid prescribing by other health professionals, “few public health efforts have focused on dental providers,” Suda said. “We were surprised by the magnitude of the difference.”

Dr. Joel Hudgins, who recently authored a study on opioid prescriptions written by ER doctors for adolescents and young adults, said he was struck by the size of the difference between English and American dentists. “The metric that matters, U.S. dentists prescribing opioids at a rate that was 70 times that of English dentists, may be a marker for how much opioids are getting into the population,” said Hudgins, a clinical instructor at Boston Children’s Hospital and Harvard Medical School.

Intriguingly, the results from the new study did fall in line with a finding from Hudgins’ study: ER doctors had prescribed opioids to nearly 60 percent of their young patients with dental complaints.

Dr. Michael Lynch suspects that similar differences in opioid prescribing would be seen if other specialties were compared.

“It’s clear that too much opioids are being prescribed and we want to make sure to reduce the rate responsibly, while making sure pain is adequately treated,” said Lynch, a toxicologist and emergency medicine physician and medical director of the Pittsburgh Poison Center at the University of Pittsburgh Medical Center.

Lynch noted that people should be careful to dispose of leftover pills, so they won’t be available for others to use.

SOURCE: JAMA Network Open, online May 24, 2019.