(4) Opioid Prescribing Patterns of Oral and Maxillofacial Surgeons at a Single Academic Institution in Southern California- A 10-year Retrospective Study

Abstract:
According to the Centers for Disease Control and Prevention (CDC), nearly 500,000 people died from an opioid drug overdose from 1999 to 2019¹. CDC coined the term “opioid epidemic” and declared it a public health emergency in 2011. The American Dental Association (ADA) recommended NSAIDs as a first-line dental pain medication². Despite the efforts from the ADA, JAMA Internal Medicine published an article that cited opioid prescriptions following dental procedures as a major contributor to the opioid epidemic in 2019³. In this study, we investigated if opioid prescribing patterns by oral and maxillofacial surgeons after dentoalveolar surgery have changed over the last 10 years.
We included a total of 4,149 patients who underwent dentoalveolar procedures with either IV general anesthesia or IV sedation from January 1, 2011, through December 31, 2021, at the Loma Linda Oral and Maxillofacial Surgery Clinic. There were 1,591 patients for wisdom teeth extraction, 2,195 patients for multiple teeth extraction (teeth number ≥ 2), 154 patients for implant placement, and 179 patients for preprosthetic surgery with or without other dentoalveolar procedures. The prescribed opioid pain medications per patient were converted to morphine milligram equivalent (MME). The changes in MME between 2011to 2016 and 2017 to 2021 were evaluated using one-way ANOVA, X² testing, and linear regression analysis; age, gender, and ethnicity were considered.
The mean MME in 2017 to 2021 (2011 to 2016) was significantly decreased in 4 treatment groups (wisdom teeth extraction: 20.5 vs 7.9, p< 0.001; multiple teeth extraction: 21.6 vs. 8.9, p< 0.001; implant placement: 22.5 vs. 12.9, p=0.001; preprosthetic surgery: 28.0 vs. 11.2, p=0.037). Linear regression of outcomes of MMEs in treatment groups of wisdom teeth extraction, multiple teeth extraction, and implant placement were shown to be statistically significantly decreased in 2017 to 2021 compared to that of 2011 to 2016 (unstandardized coefficient: -12.6, -12.6, and -9.77, respectively, all p< 0.001). This trend toward decrease in MME was maintained also in preprosthetic surgery (unstandardized coefficient: -14.8), but was not statistically significant (p=0.059).
Our study has demonstrated that OMFs are appropriately responding to the recommendations set by both federal and state government.

Reference:
1. Understanding the epidemic. Centers for Disease Control and Prevention. https://www.cdc.gov/opioids/basics/epidemic.html. Published March 17, 2021
2. American Dental Association. (n.d.). Oral analgesics for Acute Dental pain. American Dental Association. Retrieved May 25, 2022, from https://www.ada.org/resources/research/science-and-research-institute/oral-health-topics/oral-analgesics-for-acute-dental-pain
3. Schroeder AR, Dehghan M, Newman TB, Bentley JP, Park KT. 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. doi:10.1001/jamainternmed.2018.5419