UK dentists 37 times less likely to prescribe opioids than American dentists

A new joint study by researchers at the University of Sheffield and the University of Illinois has found UK dentists are 37 times less likely to prescribe opioids than dentists in the US

The findings, published recently in JAMA Network Open, suggest guidelines followed by UK dentists to prescribe non-steroidal anti-inflammatory drugs (NSAIDs) or paracetamol for dental pain management, rather than strong opioids, could be a potential method to address the US opioid crisis

The study revealed dentists are among the top prescribers of opioids in the US, prescribing them in greater quantities and stronger opioids than are necessary to control dental pain.

This increases the potential for opioid abuse.

A total of 22% of US dental prescriptions were for opioids compared to just 0.6% of dental prescriptions in the UK.

This finding remained even when adjusted for population size and number of dentists.

‘A shocking level’

‘The high level of opioid prescribing in the US is shocking,’ said Martin Thornhill, professor of translational research in dentistry at the University of Sheffield and co-author of the study.

‘Particularly, when there is good evidence that NSAIDs and acetaminophen are as good or better than opioids for treating dental pain and don’t cause the unpleasant side-affects, addiction and misuse problems associated with opioids.’

‘UK dentists manage exactly the same pain problems as their US colleagues and achieve high levels of patient satisfaction using NSAIDs and acetaminophen, without the need to resort to opioids.’

He added: ‘Unsurprisingly, more than half of opioids prescribed following tooth extraction in the US remain unused by patients.

‘This means an estimated one million opioid pills a year can be diverted to other purposes, creating a huge potential for opioid misuse.’

UK restriction

In the UK the Dental Practitioners’ Formulary, which is a list of medicines approved for use by dentists – restricts opioid prescribing to the codeine derivative dihydrocodeine which is of much lower strength than opioids regularly prescribed in the US.

Professor Thornhill and colleagues at UIC analysed nationally-representative databases from both countries.

These showed prescriptions dispensed in 2016, which is considered to be a peak point in the US opioid crisis.

Corresponding author of the study Dr Katie Suda, associate professor of pharmacy systems, outcomes and policy at UIC, said: ‘To see such a difference among two groups of dentists in countries with similar oral health and use of dentists is an indicator that opioid prescribing practices in the US warrant a second look.

‘This study tells us that efforts to adopt national guidelines for treating dental pain and for promoting conservative opioid prescribing practices among dentists in the US should be a priority and should be included as part of more comprehensive judicious opioid prescribing strategies.’

One in 10 opioids prescribed by US dentists were opioids with a high potential for abuse and diversion, such as oxycodone and long-acting opioids which are not prescribed in the UK.

Dr Susan Rowan, co-author and executive associate dean and associate dean for clinical affairs at the UIC College of Dentistry, said: ‘Dentists need to be part of the opioid conversation.’

‘This data provides substantial information and should be a wake-up call to individual dental practices and collaborative organisations of dental care providers to push the envelope towards greater efforts to reduce opioid prescribing or patients’ potential for abuse.’

The research was supported by the Agency for Healthcare Research and Quality (R01HS25177) and the National Centre for Advancing Translational Sciences (UL1TR002003).

Links

University of Ilinois at Chicago

University of Sheffield

JAMA Network Open