Dental opioid prescribing practices and risk mitigation strategy implementation: Identification of potential targets for provider-level intervention

ABSTRACT

Background: Given the regular use of immediate-release opioids for dental pain management, as well as documented opioid misuse among dental patients, the dental visit may provide a viable point of intervention to screen, identify, and educate patients regarding the risks associated with prescription opioid misuse and diversion. The aims of this statewide survey of dental practitioners were to assess (a) awareness of the scope of prescription opioid misuse and diversion; (b) current opioid prescribing practices; (c) use of and opinions regarding risk mitigation strategies; and (d) use and perceived utility of drug monitoring programs. Methods: This cross-sectional study surveyed dentists (N = 87) participating in statewide professional and alumni organizations. Dentists were invited via e-mail and listserv announcement to participate in a one-time, online, 59-item, self-administered survey. Results: A majority of respondents reported prescribing opioids (n = 66; 75.8%). A minority of respondents (n = 38; 44%) reported regularly screening for current prescription drug abuse. Dentists reported low rates of requesting prior medical records (n = 5; 5.8%). Only 38% (n = 33) of respondents had ever accessed a prescription drug monitoring program (PDMP), and only 4 (4.7%) consistently used a PDMP. Dentists reporting prior training in drug diversion were significantly more likely to have accessed their PDMP, P < .01. Interest in continuing education regarding assessment of prescription drug abuse/diversion and use of drug monitoring programs was high. Conclusions: Although most dentists received training related to prescribing opioids, findings identified a gap in existing dental training in the assessment/identification of prescription opioid misuse and diversion. Findings also identified gaps in the implementation of recommended risk mitigation strategies, including screening for prescription drug abuse, consistent provision of patient education, and use of a PDMP prior to prescribing opioids.

KEYWORDS:

• Dentists
• prescription drug monitoring program
• prescription opioids

Acknowledgments

The authors would like to thank the South Carolina Dental Association for assistance with recruitment and participating dentists for sharing their valuable perspectives.

Author contributions

All co-authors made significant contributions to the submitted manuscript. Drs. McCauley, Leite, Melvin, Fillingim, and Brady participated in the research conception and design. Drs. McCauley, Leite, Melvin, and Brady participated in the development of the survey instrument and collection of data. Dr. McCauley was responsible for the analysis and interpretation of results. Drs. McCauley, Leite, Melvin, Fillingim, and Brady all made significant contributions to the writing and editing of the manuscript.

Funding

This research was supported by the National Institute on Drug Abuse grants K12-DA031794 and K23-DA036566 and by the South Carolina Clinical & Translation Research (SCTR) Institute, with an academic home at the Medical University of South Carolina, through NIH grant UL1-TR000062. The authors declare that they have no conflicts of interest.