Dental patients with public insurance have higher risk for persistent opioid use

Patients who have public insurance had a greater risk for persistent opioid use after a dental procedure compared with patients who have private insurance, a retrospective cohort study found.

The findings by Kao-Ping Chua, MD, PhD, an assistant professor in the department of pediatrics at the University of Michigan, and colleagues were published in JAMA Network Open.

“Access to dental care is poor in the Medicaid population for many reasons, including the fact that many dentists don’t accept Medicaid and the fact that Medicaid doesn’t always have dental benefits for adults in many states,” Chua told Healio Primary Care.

He added that the study did not assess barriers to accessing care, but barriers could partly explain why persistent opioid use is more common among patients with public insurance..

“Specifically, if a Medicaid patient with dental pain is unable to undergo the procedure that fixes the underlying problem, they might be written an opioid prescription instead,” Chua said. “If they then continue to receive opioid prescriptions because they lack access to definitive therapy, they would eventually meet criteria for persistent opioid use.”

Chua and colleagues conducted a retrospective cohort study using deidentified data from IBM MarketScan Dental, Commercial and Multi-State Medicaid databases on 1,691,878 patients (women, 55.3%; mean age, 34.7 years) aged 13 to 64 years who were opioid naive and had a dental procedure between July 1, 2014, and Dec. 31, 2017. Among the study population, 37% had public insurance. The researchers defined persistent opioid use as one or more opioid prescriptions dispensed 4 to 90 days and 91 to 365 days after the procedure.

There was a 1.3% overall risk for persistent opioid use; the risk was 2% among all patients with public insurance vs. 0.9% among all patients with private insurance.

Patients who had an opioid prescription dispensed between 7 days before and 3 days after the procedure had a greater risk for persistent opioid use compared with those who did not have an initial opioid prescription, but the risk was greater among patients with public insurance, according to the researchers. Among patients with public insurance, the risk for persistent opioid use was 3.2% for those with an initial prescription dispensed vs. 1.3% for those without a prescription. Among patients with private insurance, the risk was 2% for those with an initial prescription and 0.6% for those without a prescription.

“Our findings suggest that screening for persistent opioid use should be considered for all patients who receive dental opioid prescriptions, particularly the publicly insured,” Chua said.

Primary care providers “should recognize that they have the greatest responsibility for detecting persistent opioid use associated with dental opioid prescriptions” because “most routine dental procedures don’t usually require follow up with dentists, meaning dentists are often unaware of any adverse events associated with the opioid prescriptions they write,” he added.

There are steps that primary care providers can take to prevent persistent opioid use in their patients, according to Chua.

“First, if they see a patient with a dental problem, they can recommend dentists who believe in judicious opioid prescribing,” he said. “Second, primary care providers who know their patient is about to have a dental procedure can counsel the patient on the risks of opioid prescriptions, highlight the importance of taking opioids only as prescribed, and give instructions on how to safely dispose of unused opioids.”