Excessive Dental Opioid Prescribing an Anomaly in the U.S.

The United States is in many ways, different from other nations. Many of the factors that make the U.S. a nation like no other are good things. But not all of them. The U.S. also faces struggles and challenges almost unique to this country. Case in point: the United States has one of the worst drug addiction problems in the world.

It’s a bit of an understatement to call our country’s drug issue a “problem.” Not when the opioid addiction situation by itself earned the classification of “National Public Health Emergency” in 2017. Now the drug problem has grown into a full-on addiction epidemic.

That epidemic came about from multiple causes. For one thing, the United States prescribes opioid pain relievers at an alarming rate, doling out hundreds of millions of opioid pills every year to the American populace. And it’s not just doctors who prescribe these drugs either. New research indicates that U.S. dentists are also prescribing high-strength, potentially addictive opioid pharmaceuticals to their patients, and they’re doing so at a rate that is simply unheard of in other nations.

Raising National Awareness of Opioid Overprescribing

“… All dentists treat pain worldwide, so we would not expect a large difference in which pain medication is prescribed, and our results show that U.S. dentists prescribe opioids more frequently than is likely needed.”

It is safe to say that treating oral pain problems is something that dentists often have to do. But how they go about treating such symptoms is another matter entirely. According to Dr. Katie Suda, an associate professor of pharmacy who was quoted in U.S News, “We have all probably had the experience of a terrible toothache. But all dentists treat pain worldwide, so we would not expect a large difference in which pain medication is prescribed, and our results show that U.S. dentists prescribe opioids more frequently than is likely needed.”

The U.S. News article that quoted Dr. Suda highlights data from a more comprehensive study done by the University of Illinois in Chicago. The full details of the study are published in the Journal of the American Medical Association (JAMA). It’s a good sign that major news networks are announcing information like this, raising awareness of just how dire the opioid situation truly is, but now we have to demand change, demand that opioid prescribing in the U.S. be reduced.

The Details of the Study

According to the research from the University of Illinois, U.S. dentists are far more likely to prescribe opioid pain relievers than dentists in Britain, a more or less similar country with comparable dental practices. But when it comes to pain relief for patients, the sheer disparity in dental practices one country to the next is enormous. For example, the research showed that in 2016, American dental prescriptions for opiod pain relievers was 23% of the total 11.4 million prescriptions given. British dental prescriptions for opioid pain relievers was 0.6% of the total 28,000 prescriptions for pain relievers. U.S. dentists are prescribing drugs at a rate 37 times that of British dentists.

Another way of looking at the data is that British dentists issued less than one prescription for every 1,000 Britons. In the U.S., American dentists issued 35 opioid prescriptions for every 1,000 Americans. On average, each British dentist issued just one opioid prescription in 2016. On average, each U.S. dentist issued 58 such prescriptions in 2016.

One might think that American dentists are operating under some kind of directive from a medical administration. How else could we explain the fact that almost all U.S. dentists are engaged in such seemingly excessive opioid prescribing? But that is not the case.

The American Dental Association responded to the University of Illinois study, and U.S. News cited one of their quotes. According to the ADA, “Since 2011, the ADA has advocated to keep opioid pain relievers from harming dental patients and their families and worked to raise professional awareness on medication alternatives to opioids. A growing body of research supports ADA policy that dentists should prescribe non-steroidal anti-inflammatory drugs (NSAIDs) alone or in combination with acetaminophen over opioids as first-line therapy.”

So Why the Disparity?

American dentists are not acting under guidelines or orders from the American Dental Association or any other medical board for that matter. So why then do American dentists prescribe opioid pain relievers at such a high rate?

The answer is in the overall approach to pain relief in the United States and how it is vastly different from pain relief protocols in almost all other developed nations. Here again, we have a quote from Dr. Katie Suda, the study author. She says that “In the U.K., dentists have guidelines specific to the treatment of oral pain. Unfortunately, U.S. dentists do not have guidelines to help them decide which medications to prescribe to patients. The U.K. dentists also have more stringent prescribing rules.”

Case in point, the British dental industry is under far more strict regulation as far as pain treatment goes, where-as such control is practically non-existent in the United States. The British dental sector has only one opioid pain reliever that they are even allowed to prescribe. It’s a relatively low-risk, low-strength pain reliever called “dihydrocodeine.” In the United States, dentists can prescribe whatever type of pain reliever they want.

We Need to Reform Pain Treatment in the U.S.

It’s easy enough to see everything that is wrong with this picture. Our nation is hugely lacking in regulation on opioid prescribing, to the point where our dentists can prescribe highly-addictive and mind-altering oxycodone or hydrocodone opioids for a toothache. That is not okay. We need to reform the opioid prescribing in the United States and the way pain is treated in general.

Another factor that contributes to the issue is because our health system is mostly privatized, this is often naturally conducive to a lack of regulation in pharma companys’ sway on doctors. There is actually nothing wrong with privatized healthcare in itself, but there is something very wrong with a healthcare system that becomes so unregulated that pharma companies can actually influence the care that doctors provide by offering doctors perks and incentives to prescribe pharma’s meds (even when those meds are not always needed).

We have already seen the millions addicted and the hundreds of thousands of lives lost to opioid pharmaceuticals to know that current and past methods of pain relief don’t work. It’s time for a change.

“To see such a difference between two groups of dentists in countries with similar oral health and use of dentists is an indicator that opioid prescribing practices in the U.S. warrant a second look…”

In closing, Dr. Katie Suda’s words of warning and caution on opioid prescribing in the U.S. are worth mentioning: “To see such a difference between two groups of dentists in countries with similar oral health and use of dentists is an indicator that opioid prescribing practices in the U.S. 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 U.S. should be a priority and should be included as part of more comprehensive, judicious opioid prescribing strategies.”

It’s time we all worked together and demanded change in opioid prescribing. The overprescribing of opioid drugs is only going to end when we demand it.

Sources:

• https://www.usnews.com/news/health-news/articles/2019-05-24/us-dentists-prescribe-37-times-more-opioids-than-in-england-study
• https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2734067
• https://www.eurekalert.org/pub_releases/2019-05/uoia-udo052219.php

Reviewed and Edited by Claire Pinelli, ICAADC, CCS, LADC, RAS, MCAP