COVID-19 slowed decline in US dental opioid prescriptions

Jeremy Booth, Dental Tribune International

Wed. 15. November 2023

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ANN ABOR, Mich., US: Dental opioid prescriptions are associated with an increased risk of opioid overuse, addiction and overdose, and at least 39 US states have passed laws to limit the duration of prescriptions. A recent study by researchers at the University of Michigan has found that opioid prescriptions by US dentists have been declining since January 2016, but that the outbreak of SARS-CoV-2 in the US slowed the rate of decline significantly, leading to an estimated 6.1 million additional prescriptions.

The authors analysed the IQVIA Longitudinal Prescription Database entries for the periods of January 2016 to February 2020 and June 2020 to December 2022, omitting data collection for the months of March 2020 to May 2020 to adjust for the anomaly of dental practice closures. The database tracks 92% of US retail pharmacy prescriptions, and a total of 81.2 million dental opioid prescriptions were recorded for the study periods.

The annual number of prescriptions were found to have declined from 16.1 million in 2016 to 8.9 million in 2022—a remarkable 44.7% drop. Dental opioid dispensing rates per 100,000 inhabitants were calculated, and a monthly decline of 3.9 was observed from January 2016 to February 2020. In June 2020, after the outbreak of SARS-CoV-2, the dispensing rate was found to have abruptly spiked by 31.4, and the monthly decline in the dispensing rate slowed to 2.1 for the remainder of the second study period.

The researchers found that a total of 25.0 million dental opioid prescriptions were dispensed from June 2020 to December 2020—6.1 million more than would have been expected had the decline observed from January 2016 to February 2020 continued.

Patients aged 45–64 years had the most dispensed opioid prescriptions in 2016 (32.3%) and in 2022 (29.8%). The most significant decrease was seen among patients aged 0–11 years, who accounted for 1.5% of dispensed opioid prescriptions in 2016 and 0.4% in 2022. The most significant increase was seen among those aged 65 and above, who filed 12.5% of prescriptions in 2016 and 18.8% in 2022.

“We know from research that dental pain in most patients can be controlled with non-opioid medications, avoiding the risks of opioids.”—Dr Romesh Nalliah, University of Michigan

Commenting on the general uptick in prescriptions after June 2020, the authors wrote: “Potential explanations might include a backlash against efforts to reduce opioid prescribing in the US or increases in ‘just-in-case' opioid prescribing at discharge from dental procedures owing to concerns about accessing opioids during the pandemic.” An additional hypothesis was that poor access to dental care during lockdowns had led to an increase in acutely painful dental emergencies and corresponding opioid prescriptions, they said.

“We know from research that dental pain in most patients can be controlled with non-opioid medications, avoiding the risks of opioids,” Dr Romesh Nalliah, a clinical professor at the university and co-author of the study, commented in a press release from the University of Michigan School of Dentistry. “While it’s reassuring that dental opioid prescribing is declining, the recent slowing in the decline suggests the dental profession must redouble its efforts to reduce unnecessary opioid prescribing,” he added.

According to the study, the reduced dispensing rate of 215 opioid prescriptions per 100,000 inhabitants in the US in 2020 was four times greater than that recorded in England in 2016.

The study, titled “Association between the COVID-19 outbreak and opioid prescribing by U.S. dentists”, was published online on 2 November 2023 in PLoS One.