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Abstract
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OBJECTIVES: Opioids prescribed by dentists have been associated
with serious adverse events, including opioid-related overdose and
mortality. However, the downstream outcomes of opioids prescribed by
dentists to Veterans who are at high risk for opioid misuse and overdose
have yet to be determined.
METHODS: This was a national
cross-sectional analysis of opioids associated with dental visits within
the Veterans Health Administration from 2015 to 2018. Overprescribing
was defined per guidelines as >120 morphine milligram equivalents
(MME) or >3 days supply. The association of dental visit and patient
characteristics was modeled separately for opioid-related poisoning and
all-cause mortality using logistic regression.
RESULTS: Of
137,273 Veterans prescribed an opioid by a dentist, 0.1% and 1.1% were
associated with opioid-related poisoning and mortality, respectively.
There was no difference in opioid poisoning within 6 months for Veterans
with opioid prescriptions >120 MME (aOR = 1.25 [CI: 0.89-1.78]), but
poisoning decreased in Veterans prescribed opioids >3-days supply
(aOR = 0.68 [CI: 0.49-0.96]). However, Veterans with opioids >120 MME
were associated with higher odds of mortality within 6 months
(aOR = 1.17 [95% CI: 1.05-1.32]) while there was no difference in
prescriptions >3-days supply (aOR = 1.12 [CI: 0.99-1.25]).
CONCLUSION:
Serious opioid-related adverse events were rare in Veterans and lower
than other reports in the literature. Since nonopioid analgesics have
superior efficacy for the treatment of acute dental pain, prescribing
opioid alternatives may decrease opioid-related poisoning. Strategies
for dentists to identify patients at high risk should be incorporated |
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