Initial opioid prescribing and subsequent opioid use after dental procedures among opioid-naive patients in Pennsylvania Medicaid, 2012 through 2017

Abstract

Background: Little is known about how opioid prescribing differs for dental procedures with low, moderate, or high pain or whether that prescribing is associated with continued opioid use.

Methods: The authors used Pennsylvania Medicaid claims data from 2012 through 2017. They categorized dental procedures into 3 groups of pain (low, moderate, high). Using multivariable logistic regression models with random intercept, the authors estimated the probability of receiving an initial opioid prescription within 7 days before and 3 days after a dental procedure associated with the pain categories and assessed subsequent short- and long-term (4-90 days and 91-365 days, respectively) opioid use.

Results: The authors identified 1,345,360 index dental procedures (among 912,121 enrollees), of which 67.6% were categorized as low pain, 1.6% as moderate pain, and 30.9% as high pain. Predicted probability of an initial opioid prescription was 2.4% (95% CI, 2.4% to 2.5%) for low-pain, 8.3% (95% CI, 7.9% to 8.6%) for moderate-pain, and 31.8% (95% CI, 31.6% to 31.9%) for high-pain procedures. Predicted probabilities for short-term use for those who did not fill versus those who did fill an opioid prescription were 0.9% (95% CI, 0.9% to 1.0%) versus 25.0% (95% CI, 24.5% to 25.6%) for the low-pain, 1.6% (95% CI, 1.4% to 1.8%) versus 16.6% (95% CI, 14.9% to 18.4%) for moderate-pain, and 2.9% (95% CI, 2.8% to 3.0%) versus 13.5% (95% CI, 13.3% to 13.7%) for the high-pain groups.

Conclusions: Although enrollees undergoing high-pain dental procedures were more likely to fill an initial opioid prescription than their counterparts with low- to moderate-pain procedures, the relative risk of experiencing sustained opioid use (4-90 days postprocedure) was highest in the low-pain group.

Practical implications: More attention should be paid to reducing opioid prescribing for dental procedures with low pain risk.

Keywords: Opioid; oral health; repeat prescriptions.