A longitudinal cohort study of opioid prescriptions associated with nonsurgical dental visits among Oregon and New York state Medicaid beneficiaries, 2014-2016

Abstract

BackgroundStudies estimate that approximately one-third of all opioid prescriptions (Rxs) from dentists are associated with nonsurgical dental procedures, which suggests unwarranted opioid use. MethodsThe authors conducted a retrospective longitudinal cohort study of adult Medicaid beneficiaries using administrative claims data from New York (NY) and Oregon (OR) (2014-2016) to examine opioid Rxs associated with nonsurgical dental visits. The primary outcomes were the number of all opioid Rxs from dentists compared with nondentists, number of opioid Rxs associated with surgical and nonsurgical dental visits, time to subsequent dental visits and visit type, and total dental morphine milligram equivalents (MMEs) received during the 90 days after an opioid-related, nonsurgical dental visit. ResultsDentists prescribed 6.9% (NY) and 11.9% (OR) of all opioid Rxs during the 3-year study period. One-third of all opioid-related dental visits were nonsurgical and one-half of the subsequent dental visits were either nonsurgical or did not occur within 90 days. Mean time to a subsequent dental visit was 3 weeks. Beneficiaries with a surgical dental follow-up visit received significantly higher total MMEs (NY: 1.19 MMEs; OR: 1.21 MMEs; P < .001) for each additional day before the follow-up visit compared with nonsurgical dental follow-up visits. ConclusionsMedicaid beneficiaries might be exposed to unnecessary opioid Rxs in situations in which they may not be indicated or effective and without a plan for more definitive treatment. Practical ImplicationsDentists need to avoid delays in scheduling definitive treatment and take appropriate steps to monitor prescribed opioid use to reduce the well-known risks associated with undue or prolonged opioid exposure.