Abstract
The United States consumes most of the opioids worldwide despite representing a small portion of the world's population. Dentists are one of the most frequent US prescribers of opioids despite data suggesting that nonopioid analgesics are similarly effective for oral pain. While oral health and dentist use are generally similar between the United States and England, it is unclear how opioid prescribing by dentists varies between the 2 countries. To compare opioid prescribing by dentists in the United States and England. Cross-sectional study of prescriptions for opioids dispensed from outpatient pharmacies and health care settings between January 1 and December 31, 2016, by dentists in the United States and England. Data were analyzed from October 2018 to January 2019. Opioids prescribed by dentists. Proportion and prescribing rates of opioid prescriptions. In 2016, the proportion of prescriptions written by US dentists that were for opioids was 37 times greater than the proportion written by English dentists. In all, 22.3% of US dental prescriptions were opioids (11.4 million prescriptions) compared with 0.6% of English dental prescriptions (28 082 prescriptions) (difference, 21.7%; 95% CI, 13.8%-32.1%; P < .001). Dentists in the United States also had a higher number of opioid prescriptions per 1000 population (35.4 per 1000 US population [95% CI, 25.2-48.7 per 1000 population] vs 0.5 per 1000 England population [95% CI, 0.03-3.7 per 1000 population]) and number of opioid prescriptions per dentist (58.2 prescriptions per dentist [95% CI, 44.9-75.0 prescriptions per dentist] vs 1.2 prescriptions per dentist [95% CI, 0.2-5.6 prescriptions per dentist]). While the codeine derivative dihydrocodeine was the sole opioid prescribed by English dentists, US dentists prescribed a range of opioids containing hydrocodone (62.3%), codeine (23.2%), oxycodone (9.1%), and tramadol (4.8%). Dentists in the United States also prescribed long-acting opioids (0.06% of opioids prescribed by US dentists [6425 prescriptions]). Long-acting opioids were not prescribed by English dentists. This study found that in 2016, dentists in the United States prescribed opioids with significantly greater frequency than their English counterparts. Opioids with a high potential for abuse, such as oxycodone, were frequently prescribed by US dentists but not prescribed in England. These results illustrate how 1 source of opioids differs substantially in the United States vs England. To reduce dental opioid prescribing in the United States, dentists could adopt measures similar to those used in England, including national guidelines for treating dental pain that emphasize prescribing opioids conservatively.
Highlights
Dentists are among the most frequent prescribers of opioids in the United States, second after family physicians.[1,2] While per capita prescribing of opioids is decreasing nationally,[3] dental prescribing rates are increasing.[4]
Dentists in the United States had a higher number of opioid prescriptions per 1000 population (35.4 per 1000 US population [95% CI, 25.2-48.7 per 1000 population] vs 0.5 per 1000 England population [95% CI, 0.03-3.7 per 1000 population]) and number of opioid prescriptions per dentist (58.2 prescriptions per dentist [95% CI, 44.9-75.0 prescriptions per dentist] vs 1.2 prescriptions per dentist [95% CI, 0.2-5.6 prescriptions per dentist])
The proportion of all dental prescriptions written for opioids was 37 times greater in the United States than in England (22.3% of US dental prescriptions were for opioids vs 0.6% of English dental prescriptions; difference, 21.7%; 95% CI, 13.8%-32.1%; P < .001)
Summary
Dentists are among the most frequent prescribers of opioids in the United States, second after family physicians.[1,2] While per capita prescribing of opioids is decreasing nationally,[3] dental prescribing rates are increasing.[4]. Opioid use varies significantly by country.[9] The United States consumes most of the global opioid supply despite representing only 4% of the world’s population.[9] Compared with the United States, England has lower overall opioid prescribing rates.[9,10] One of the reasons opioid prescribing may be lower is because of differing prescribing patterns among dentists. Dental care is subsidized as part of the public benefit in the United Kingdom’s (UK) National Health Service (NHS), while 23% of the US population does not have dental insurance.[11] To inform the debate about dental opioid prescribing, we used nationally representative data to compare opioid prescribing between dentists in the United States and England
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