Chua KP; Hu HM; Waljee JF; Brummett CM; Nalliah RP. Opioid prescribing patterns by dental procedure among US publicly and privately insured patients, 2013 through 2018. JADA. Published online 23 February 2021. DOI: https://doi.org/10.1016/j.adaj.2021.01.001
Five procedures accounted for 95.2% of dental opioid prescriptions, and tooth extraction accounted for almost two-thirds of total prescriptions;
Tooth extraction accounted for ⅘ of prescriptions for adolescents and young adults and ⅗ of prescriptions for adults aged 26 through 64 years.
In 2018, 45.3% of tooth extractions resulted in 1 or more initial prescriptions
Fry BT; Howard RA; Gunaseelan V; Lee JS; Waljee JF; Englesbe MJ; Vu JV. Association of Postoperative Opioid Prescription Size and Patient Satisfaction. Annals of Surgery. Published online 1 February 2021. DOI: 10.1097/SLA.0000000000004784
No significant association between opioid prescription size and satisfaction
83% of patients receiving the smallest opioid prescription (25 mg OME) were satisfied compared to 85% of patients receiving the largest opioid prescription size (750 mg OME)
Harbaugh CM, Vargas G, Streur CS, et al. Eliminating Unnecessary Opioid Exposure After Common Children's Surgeries. JAMA Surg. 2019;154(12):1154-1155. doi:10.1001/jamasurg.2019.2529
A discharge opioid was prescribed to 22% of 675 children younger than 18 years
Median 10 doses (25th to 75th percentile, 6-15)
Circumcision, elbow fracture, and orchiopexy had the highest opioid use; yet only 1 in 3 patients used an opioid, typically for 3 days or less.
Overall, pain control was reported as good among 82% of children with or without a discharge opioid prescription.
Howard R, Fry B, Gunaseelan V, et al. Association of Opioid Prescribing With Opioid Consumption After Surgery in Michigan. JAMA Surg. 2019;154(1):e184234. doi:10.1001/jamasurg.2018.4234
Patients use only 27% of opioids prescribed to them
Patients use an additional 5 pills for every 10 extra pills prescribed to them
The quantity of opioid prescribed is associated with higher patient-reported opioid consumption
Greater association between prescription size and consumption than reported pain levels and consumption
Larach DB, Waljee JF, Hu HM, et al. Patterns of Initial Opioid Prescribing to Opioid-Naive Patients. Ann Surg. 2020;271(2):290-295. doi:10.1097/SLA.0000000000002969
The proportion of initial prescriptions for surgery, emergency, and dental care increased by nearly 16% from 2010 to 2016.
Dental care prescribing saw the greatest growth, with a 68% increase, while surgical patients received the highest proportion of potent opioids (90.2%).
Howard R, Waljee J, Brummett C, Englesbe M, Lee J. Reduction in Opioid Prescribing Through Evidence-Based Prescribing Guidelines. JAMA Surg. 2018;153(3):285-287. doi:10.1001/jamasurg.2017.4436
Prior to the intervention, post-laparoscopic cholecystectomy (gall bladder removal surgery) opioid prescribing exceeded patient pain management needs by approximately 88%, based on patient- reported opioid use.
Implementation of evidence-based prescribing guidelines reduced post-laparoscopic cholecystectomy opioid prescribing by 63% without increasing the need for medication refills.
Patients who received smaller opioid prescriptions after the intervention reported using fewer opioids, indicating that anchoring and adjustment heuristics may impact patient opioid use.
