In the Emergency Department, we appreciate all the various sources of opiates in our healthcare system. We are, after all, effectively the last-resort after-hours refill destination – and patients with dental complaints are not uncommon.
These authors performed a retrospective, claims-based analysis of adolescents and young adults with exposures to opiates via a dental provider. In this database, there were 754,002 patients with continuous enrollment during the study period, 97,462 of whom received at least one prescription for an opiate. Of these, 29,791 (30.6%) received a prescription from a dental clinician. As compared with a randomly-selected opiate non-exposed cohort, the difference between subsequent healthcare encounters with an opioid abuse-related diagnosis was profound: 5.6% of the exposed cohort, compared with 0.4% of those unexposed.
It’s the same sort of high-level analysis with vast gulfs of inference as the “Emergency Physicians Are The Problem” article in the NEJM a few months back. It has obvious face validity, however, that an exposure to a potentially dependence-forming medication can result in downstream harms. Dental providers are not obviously any greater problem than other surgical specialties, but, yes, we are all similarly responsible for appropriate prescribing practices.
I also incidentally applaud these authors for their use of absolute risk differences – it would have been all too easy to breathlessly report relative risks, considering the low prevalence of opioid-abuse among “controls”.
“Association of Opioid Prescriptions From Dental Clinicians for US Adolescents and Young Adults With Subsequent Opioid Use and Abuse”
https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2717503