Adolescents and Young Adults Receiving Dental Opioid Prescriptions May Experience Continued Opioid Use and OUD

Wisdom tooth extraction is a rite of passage for many adolescents and young adults that is often accompanied by a prescription for an opioid analgesic. Exposure to opioids can lead to continued use and development of opioid use disorder (OUD). Researchers used data from a commercial insurance database to investigate the associations between receiving an opioid prescription after a dental encounter and continued opioid use (defined as receiving another prescription 90–365 days after the index prescription) and health care encounters for OUD within 365 days.

• Among patients aged 16–25 who had continuous coverage for one year (754,000 individuals), 97,462 (13%) received an opioid prescription; of these, 29,791 received their first opioid prescription from a dental clinician (31% of those who received an opioid).
• Of those who received an opioid, 7% received another prescription for an opioid 90–365 days later, compared with 0.1% of an opioid-nonexposed comparison cohort.
• Of those who received an opioid, 6% had at least one subsequent health care encounter associated with OUD within a year, compared with 0.4% in the opioid-nonexposed cohort.
• The quantity of opioid prescribed (more or less than 20 pills) was not associated with persistent use or subsequent OUD.

Comments: This study adds to a growing body of evidence demonstrating that even short-term exposure to prescription opioids can lead to persistent use and OUD in those susceptible. Guidelines recommending prescribing smaller quantities of opioids may not reduce these risks. Given that there is no evidence that opioids are more effective than nonsteroidal anti-inflammatory drugs for analgesia after minor procedures, they should not be routinely prescribed, especially to those at a vulnerable younger age.

Darius A. Rastegar, MD

Reference: Schroeder AR, Dehghan M, Newman TB, et al. Association of opioid prescriptions from dental clinicians for US adolescents and young adults with subsequent opioid use and abuse. JAMA Intern Med. 2019;179(2):145–152.