Advertisement

Characteristics Associated With Opioid and Antibiotic Prescribing by Dentists

      Introduction

      The objective of this study is to identify county-level characteristics that may be high-impact targets for opioid and antibiotic interventions to improve dental prescribing.

      Methods

      Prescriptions during 2012–2017 were extracted from the IQVIA Longitudinal Prescription database. Primary outcomes were yearly county-level antibiotic and opioid prescribing rates. Multivariable negative binomial regression identified associations between prescribing rates and county-level characteristics. All analyses occurred in 2020.

      Results

      Over time, dental opioid prescribing rates decreased by 20% (from 4.02 to 3.22 per 100 people), whereas antibiotic rates increased by 5% (from 6.85 to 7.19 per 100 people). Higher number of dentists per capita, higher proportion of female residents, and higher proportion of residents aged <65 years were associated with increased opioid rates. Relative to location in the West, location in the Northeast (59%, 95% CI=52, 65) and Midwest (64%, 95% CI=60, 70) was associated with lower opioid prescribing rates. Higher clinician density, median household income, proportion female, and proportion White were all independently associated with higher antibiotic rates. Location in the Northeast (149%, 95% CI=137, 162) and Midwest (118%, 95% CI=111, 125) was associated with higher antibiotic rates. Opioid and antibiotic prescribing rates were positively associated.

      Conclusions

      Dental prescribing of opioids is decreasing, whereas dental antibiotic prescribing is increasing. High prescribing of antibiotics is associated with high prescribing of opioids. Strategies focused on optimizing dental antibiotics and opioids are needed given their impact on population health.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      REFERENCES

        • Centers for Disease Control and Prevention
        Antibiotic resistance threats in the United States, 2019.
        Centers for Disease Control and Prevention, Atlanta, GA2019 (Published December 2019. Accessed December 16, 2020)
        • Scholl L
        • Seth P
        • Kariisa M
        • Wilson N
        • Baldwin G
        • Release E.
        Drug and opioid-involved overdose deaths - United States, 2013-2017.
        MMWR Morb Mortal Wkly Rep. 2019; 67: 1419-1427https://doi.org/10.15585/mmwr.mm675152e1
      1. Nearly half a million Americans suffered from Clostridium difficile infections in a single year [press release]. Atlanta, GA: CDC Newsroom; February 25, 2015. http://www.cdc.gov/media/releases/2015/p0225-clostridium-difficile.html. Accessed 4 February 2017.

      2. The White House. National action plan for combating antibiotic-resistant bacteria. Washington, DC: The White House.https://www.cdc.gov/drugresistance/pdf/national_action_plan_for_combating_antibotic-resistant_bacteria.pdf. Published March 2015. Accessed December 16, 2020.

      3. National action plan for ADE prevention. HHS, Office of Disease Prevention and Health Promotion. https://health.gov/our-work/health-care-quality/adverse-drug-events/national-ade-action-plan. Updated July 24, 2020. Accessed December 16, 2020.

        • Cope AL
        • Chestnutt IG.
        Inappropriate prescribing of antibiotics in primary dental care: reasons and resolutions.
        Prim Dent J. 2014; 3: 33-37https://doi.org/10.1308/205016814813877333
        • Ringwalt C
        • Gugelmann H
        • Garrettson M
        • et al.
        Differential prescribing of opioid analgesics according to physician specialty for Medicaid patients with chronic noncancer pain diagnoses.
        Pain Res Manag. 2014; 19: 179-185https://doi.org/10.1155/2014/857952
        • Volkow ND
        • McLellan TA
        • Cotto JH
        • Karithanom M
        • Weiss SR.
        Characteristics of opioid prescriptions in 2009.
        JAMA. 2011; 305: 1299-1301https://doi.org/10.1001/jama.2011.401
        • Epstein JB
        • Chong S
        • Le ND.
        A survey of antibiotic use in dentistry.
        J Am Dent Assoc. 2000; 131: 1600-1609https://doi.org/10.14219/jada.archive.2000.0090
        • Wilson W
        • Taubert KA
        • Gewitz M
        • et al.
        Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group [published correction appears in Circulation. 2007;116(15):e376–e377].
        Circulation. 2007; 116: 1736-1754https://doi.org/10.1161/CIRCULATIONAHA.106.183095
        • Rethman MP
        • Watters 3rd, W
        • Abt E
        • et al.
        The American Academy of Orthopaedic Surgeons and the American Dental Association clinical practice guideline on the prevention of orthopaedic implant infection in patients undergoing dental procedures.
        J Bone Joint Surg Am. 2013; 95: 745-747https://doi.org/10.2106/00004623-201304170-00011
        • American Dental Association, American Academy of Orthopedic Surgeons
        Antibiotic prophylaxis for dental patients with total joint replacements.
        J Am Dent Assoc. 2003; 134: 895-899https://doi.org/10.14219/jada.archive.2003.0289
        • Suda KJ
        • Calip GS
        • Zhou J
        • et al.
        Assessment of the appropriateness of antibiotic prescriptions for infection prophylaxis before dental procedures, 2011 to 2015.
        JAMA Netw Open. 2019; 2e193909https://doi.org/10.1001/jamanetworkopen.2019.3909
        • Yingling NM
        • Byrne BE
        • Hartwell GR.
        Antibiotic use by members of the American Association of Endodontists in the year 2000: report of a national survey.
        J Endod. 2002; 28: 396-404https://doi.org/10.1097/00004770-200205000-00012
        • Wright ER
        • Kooreman HE
        • Greene MS
        • Chambers RA
        • Banerjee A
        • Wilson J.
        The iatrogenic epidemic of prescription drug abuse: county-level determinants of opioid availability and abuse.
        Drug Alcohol Depend. 2014; 138: 209-215https://doi.org/10.1016/j.drugalcdep.2014.03.002
        • McCauley JL
        • Leite RS
        • Melvin CL
        • Fillingim RB
        • Brady KT.
        Dental opioid prescribing practices and risk mitigation strategy implementation: identification of potential targets for provider-level intervention.
        Subst Abus. 2016; 37: 9-14https://doi.org/10.1080/08897077.2015.1127870
        • Porucznik CA
        • Johnson EM
        • Rolfs RT
        • Sauer BC.
        Specialty of prescribers associated with prescription opioid fatalities in Utah, 2002-2010.
        Pain Med. 2014; 15: 73-78https://doi.org/10.1111/pme.12247
        • Aldous JA
        • Engar RC
        Analgesic prescribing patterns in a group of dentists.
        Gen Dent. 2000; 48 (Accessed December 16, 2020): 586-590
        • Baker JA
        • Avorn J
        • Levin R
        • Bateman BT.
        Opioid prescribing after surgical extraction of teeth in Medicaid patients, 2000-2010.
        JAMA. 2016; 315: 1653-1654https://doi.org/10.1001/jama.2015.19058
        • Suda KJ
        • Zhou J
        • Rowan SA
        • et al.
        Overprescribing of opioids to adults by dentists in the U.S., 2011-2015.
        Am J Prev Med. 2020; 58: 473-486https://doi.org/10.1016/j.amepre.2019.11.006
        • Suda KJ
        • Durkin MJ
        • Calip GS
        • et al.
        Comparison of opioid prescribing by dentists in the United States and England.
        JAMA Netw Open. 2019; 2e194303https://doi.org/10.1001/jamanetworkopen.2019.4303
      4. Boardman C, inventor; IMS Health Inc., assignee. System and method for estimating product distribution using a product specific universe; U.S. patent7,174,304. February 6, 2007. https://patents.google.com/patent/US7174304B1. Accessed February 17, 2021.

        • Hicks LA
        • Bartoces MG
        • Roberts RM
        • et al.
        U.S. outpatient antibiotic prescribing variation according to geography, patient population, and provider specialty in 2011.
        Clin Infect Dis. 2015; 60: 1308-1316https://doi.org/10.1093/cid/civ076
        • Stroup W.
        Generalized Linear Mixed Models: Modern Concepts, Methods and Applications.
        Taylor & Francis Group, Boca Raton, FL2013https://doi.org/10.1201/b13151
        • Schieber LZ
        • Guy Jr., GP
        • Seth P
        • et al.
        Trends and patterns of geographic variation in opioid prescribing practices by state, United States, 2006-2017 [published correction appears in JAMA Netw Open. 2019;2(5):e194307].
        JAMA Netw Open. 2019; 2e190665https://doi.org/10.1001/jamanetworkopen.2019.0665
        • Guy Jr., GP
        • Zhang K
        • Bohm MK
        • et al.
        Vital signs: changes in opioid prescribing in the United States, 2006-2015.
        MMWR Morb Mortal Wkly Rep. 2017; 66: 697-704https://doi.org/10.15585/mmwr.mm6626a4
        • Arizpe A
        • Reveles KR
        • Aitken SL.
        Regional variation in antibiotic prescribing among Medicare part D enrollees, 2013.
        BMC Infect Dis. 2016; 16: 744https://doi.org/10.1186/s12879-016-2091-0
        • McDonald DC
        • Carlson K
        • Izrael D.
        Geographic variation in opioid prescribing in the U.S.
        J Pain. 2012; 13: 988-996https://doi.org/10.1016/j.jpain.2012.07.007
        • Kim JK
        • Baker LA
        • Seirawan H
        • Crimmins EM.
        Prevalence of oral health problems in U.S. adults, NHANES 1999-2004: exploring differences by age, education, and race/ethnicity.
        Spec Care Dentist. 2012; 32: 234-241https://doi.org/10.1111/j.1754-4505.2012.00280.x
        • Janakiram C
        • Chalmers NI
        • Fontelo P
        • et al.
        Sex and race or ethnicity disparities in opioid prescriptions for dental diagnoses among patients receiving Medicaid [published correction appears in J Am Dent Assoc. 2019;150(10):e135–e144].
        J Am Dent Assoc. 2018; 149: 246-255https://doi.org/10.1016/j.adaj.2018.02.010
        • Jung S
        • Sexton ME
        • Owens S
        • Spell N
        • Fridkin S.
        Variability of antibiotic prescribing in a large healthcare network despite adjusting for patient-mix: reconsidering targets for improved prescribing.
        Open Forum Infect Dis. 2019; 6 (ofz018)https://doi.org/10.1093/ofid/ofz018
        • Steinmetz CN
        • Zheng C
        • Okunseri E
        • Szabo A
        • Okunseri C.
        Opioid analgesic prescribing practices of dental professionals in the United States.
        JDR Clin Transl Res. 2017; 2: 241-248https://doi.org/10.1177/2380084417693826
        • Rasubala L
        • Pernapati L
        • Velasquez X
        • Burk J
        • Ren YF.
        Impact of a mandatory prescription drug monitoring program on prescription of opioid analgesics by dentists.
        PLoS One. 2015; 10e0135957https://doi.org/10.1371/journal.pone.0135957
        • Bohnert ASB
        • Guy GP
        • Losby JL.
        Opioid prescribing in the United States before and after the Centers for Disease Control and Prevention's 2016 opioid guideline.
        Ann Intern Med. 2018; 169: 367-375https://doi.org/10.7326/M18-1243
        • Soelberg CD
        • Brown Jr, RE
        • Du Vivier D
        • Meyer JE
        • Ramachandran BK
        The U.S. opioid crisis: current federal and state legal issues.
        Anesth Analg. 2017; 125: 1675-1681https://doi.org/10.1213/ANE.0000000000002403
        • Rutkow L
        • Chang HY
        • Daubresse M
        • Webster DW
        • Stuart EA
        • Alexander GC.
        Effect of Florida's prescription drug monitoring program and pill mill laws on opioid prescribing and use.
        JAMA Intern Med. 2015; 175: 1642-1649https://doi.org/10.1001/jamainternmed.2015.3931
        • King LM
        • Bartoces M
        • Fleming-Dutra KE
        • Roberts RM
        • Hicks LA.
        Changes in U.S. outpatient antibiotic prescriptions from 2011-2016.
        Clin Infect Dis. 2020; 70: 370-377https://doi.org/10.1093/cid/ciz225
        • Sanchez GV
        • Fleming-Dutra KE
        • Roberts RM
        • Hicks LA.
        Core elements of outpatient antibiotic stewardship.
        MMWR Recomm Rep. 2016; 65: 1-12https://doi.org/10.15585/mmwr.rr6506a1
        • Gross AE
        • Hanna D
        • Rowan SA
        • Bleasdale SC
        • Suda KJ.
        Successful Implementation of an antibiotic stewardship program in an academic dental practice.
        Open Forum Infect Dis. 2019; 6: ofz067https://doi.org/10.1093/ofid/ofz067