June JADA examines opioid prescription fills before weekends, holidays

June JADA Cover
In a study published in the June issue of The Journal of the American Dental Association, patients were more likely to fill an opioid prescription for an outpatient dental procedure performed the day before a weekend or holiday than on another weekday.

The cover story, "Increased Opioid Prescription Fills After Dental Procedures Performed Before Weekends and Holidays," looked at opioid fill data for 2,060,317 people aged 13-64 who underwent eligible dental procedures between 2013 and 2017 and had not previously filled an opioid prescription within 90 days of the procedure. The study used insurance claims data from the Truven Health MarketScan warehouse, which offers data for nearly 240 million Americans with employer-sponsored health insurance.

The researchers found outpatient dental procedures occurring the day before a weekend or holiday were associated with a 27% increased adjusted odds of filling an opioid prescription compared to procedures occurring on other weekdays.

"Variation in opioid prescription fills may put some patients at increased risk," said Caitlin R. Priest, first author of the article and a medical student at the University of Michigan in Ann Arbor, Michigan. "Now that we understand that dental opioid prescription fills were increased on Fridays and before holidays, we can create and disseminate best practices to avoid unnecessary prescribing."

In the article, the researchers advise that opioids are not warranted for most dental procedures and should be replaced with patient education and nonopioid analgesics. They suggest that dental health care professionals concerned about post-procedural pain control consider scheduling complex procedures when emergency care is available earlier in the week to reduce the preemptive prescribing of opioids.

"The significance of our study is that, with the help of big data, it begins to unpack potentially harmful opioid-prescribing trends that were not previously understood," said Dr. Romesh P. Nalliah, co-author of the article and associate dean for patient services and clinical professor of dentistry at the University of Michigan School of Dentistry. "In the event that we have particular concerns about a given case or patient, we can more deliberately book surgeries when we are available to follow up."

Some limitations of the study include that it does not capture patients who received a prescription they chose not to fill and it lacks insight on the counseling patients received about their prescription.

Other articles in the June issue of JADA discuss carious lesion detection in primary molars, blood spatter in oral surgery, and oral disorders and verbal bullying.

Every month, JADA articles are published online at JADA.ADA.org in advance of the print publication.