Initial opioid prescribing and subsequent opioid use after dental procedures among opioid-naive patients in Pennsylvania Medicaid, 2012 2017

Background. Little is known about how opioid prescribing differs for dental procedures with low, moderate, or high pain or whether that prescribing is associated with continued opioid use. Methods. The authors used Pennsylvania Medicaid claims data from 2012 through 2017. They categorized dental procedures into 3 groups of pain (low, moderate, high). Using multivariable logistic regression models with random intercept, the authors estimated the probability of receiving an initial opioid prescription within 7 days before and 3 days after a dental procedure associated with the pain categories and assessed subsequent short-and long-term (4-90 days and 91-365 days, respectively) opioid use. Results. The authors identified 1,345,360 index dental procedures (among 912,121 enrollees), of which 67.6% were categorized as low pain, 1.6% as moderate pain, and 30.9% as high pain. Predicted probability of an initial opioid prescription was 2.4% (95% CI, 2.4% to 2.5%) for low-pain, 8.3% (95% CI, 7.9% to 8.6%) for moderate-pain, and 31.8% (95% CI, 31.6% to 31.9%) for high pain procedures. Predicted probabilities for short-term use for those who did not fill versus those who did fill an opioid prescription were 0.9% (95% CI, 0.9% to 1.0%) versus 25.0% (95% CI, 24.5% to 25.6%) for the low-pain, 1.6% (95% CI, 1.4% to 1.8%) versus 16.6% (95% CI, 14.9% to 18.4%) for moderate-pain, and 2.9% (95% CI, 2.8% to 3.0%) versus 13.5% (95% CI, 13.3% to 13.7%) for the high-pain groups. Conclusions. Although enrollees undergoing high-pain dental procedures were more likely to fill an initial opioid prescription than their counterparts with low-to moderate-pain procedures, the relative risk of experiencing sustained opioid use (4-90 days postprocedure) was highest in the low pain group. Practical Implications. More attention should be paid to reducing opioid prescribing for dental procedures with low pain risk.