Science in the News
Mandatory Monitoring Impact on Opioid Prescribing by Dentists
November 13, 2015
Although 49 states in the U.S. have implemented prescription drug monitoring programs (PDMP) designed to track data from health care providers on controlled substance prescriptions statewide, most of these are voluntary.1 In August 2013, New York became one of the first states to mandate that prescribers consult the state's PDMP registry (the “Internet System for Tracking Over-Prescribing,” or iSTOP) before prescribing a controlled substance. A recent study from the University of Rochester’s Eastman Institute for Oral Health examined the effect of this mandatory program on frequency and quantity of opioid prescriptions by dentists in a dental urgent care center in the Greater Rochester area.2
Researchers surveyed patient electronic medical records for a 3-month period following implementation of the mandatory PDMP and compared them to records from the same time period the prior year (December through February, pre-iSTOP [n=1921 records] and post-iSTOP-1 [n=2011]). To determine consistency of results, records were analyzed for an additional 3-month period (March through May, post-iSTOP-2 [n=2272]). Data collected included number of visits, type of treatment by ADA CDT code, and drug prescriptions (including drug, dosages, and quantities [i.e., total number of pills]).
More than half of patients received pain medications in each of the 3-month periods examined: 76.8% (pre-iSTOP), 67.0% (post-iSTOP-1), and 64.1% (post-iSTOP-2). Of these patients, 30.6% received opioid analgesics pre-iSTOP; this decreased significantly to 14.1% post-iSTOP-1 and 9.6% post-iSTOP-2 (p<0.05). Over the three time periods examined, total numbers of prescriptions written for hydrocodone, codeine, and oxycodone decreased significantly, while those for acetaminophen increased significantly (both p<0.05). Although ibuprofen prescriptions increased by 19.8%, this was not statistically significant. By the end of the study, the total quantity of opioid analgesics prescribed in a 3-month period had decreased from 5096 to 1120 pills, which was a 78% reduction in absolute quantity.
Although it was noted that the number of surgical extractions was significantly higher in the pre-iSTOP period compared with the two post-iSTOP periods (406 vs. 257 and 269, respectively), the authors attributed this to the establishment of a referral relationship with an oral surgery specialty clinic within the same institution. After adjustment for the frequency of surgical extractions, the odds for a patient to receive opioid analgesics was reduced by 58% (odds ratio [OR]=0.42, 95% confidence interval [CI]: 0.35, 0.51) in post-iSTOP-1 and 72% (OR 0.28, 95% CI: 0.23, 0.34) in post-iSTOP-2, as compared to the pre-iSTOP period (p<0.05).The authors posited that implementation of a mandatory PDMP resulted in a practice shift towards evidence-based prescription practices for acute postoperative dental pain (i.e., combination ibuprofen/acetaminophen for acute postoperative dental pain management3).
1. Haffajee RL, Jena AB, Weiner SG. Mandatory use of prescription drug monitoring programs. JAMA 2015;313(9):891-92.
2. Rasubala L, Pernapati L, Velasquez X, Burk J, Ren Y-F. Impact of a mandatory prescription drug monitoring program on prescription of opioid analgesics by dentists. PLoS ONE 2015;10(8):e0135957.
3. Moore PA, Hersh EV. Combining ibuprofen and acetaminophen for acute pain management after third-molar extractions: translating clinical research to dental practice. J Am Dent Assoc 2013;144(8):898-908.
Prepared by: Center for Science Information, ADA Science Institute
Last updated: November 13, 2015
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