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Distribution of Opioid Prescribing and High-Risk Prescribing Among U.S. Dentists in 2019

  • Kao-Ping Chua
    Correspondence
    Address correspondence to: Kao-Ping Chua, MD, PhD, Department of Pediatrics, Susan B. Meister Child Health Evaluation and Research Center, University of Michigan Medical School, 300 North Ingalls Street, SPC 5456, Room 6E18, Ann Arbor MI 48109.
    Affiliations
    Department of Pediatrics, Susan B. Meister Child Health Evaluation and Research Center, University of Michigan Medical School, Ann Arbor, Michigan

    Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan
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  • Jennifer F. Waljee
    Affiliations
    Michigan Opioid Prescribing Engagement Network, Institute for Healthcare Policy & Innovation, University of Michigan Medical School, Ann Arbor, Michigan

    Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, Michigan
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  • Vidhya Gunaseelan
    Affiliations
    Michigan Opioid Prescribing Engagement Network, Institute for Healthcare Policy & Innovation, University of Michigan Medical School, Ann Arbor, Michigan
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  • Romesh P. Nalliah
    Affiliations
    University of Michigan School of Dentistry, Ann Arbor, Michigan
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  • Chad M. Brummett
    Affiliations
    Michigan Opioid Prescribing Engagement Network, Institute for Healthcare Policy & Innovation, University of Michigan Medical School, Ann Arbor, Michigan

    Division of Pain Medicine, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan
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      Introduction

      It is unknown whether certain dentists account for disproportionate shares of dental opioid prescriptions and high-risk prescriptions. Identifying and characterizing such dentists could inform the targeting of initiatives to improve the appropriateness and safety of dental opioid prescribing.

      Methods

      In May 2021, the authors conducted a cross-sectional analysis using the IQVIA Longitudinal Prescription Database, which reports dispensing from 92% of U.S. pharmacies, and 2 provider databases (IQVIA OneKey, National Plan and Provider Enumeration System). Analyses included opioid prescriptions from dentists dispensed in 2019 to patients aged >12 years. High-risk prescriptions were those considered high risk by any of 3 metrics (prescriptions to opioid-naïve patients exceeding a 3-day supply, prescriptions with daily opioid dosage ≥50 morphine milligram equivalents, opioid prescriptions with benzodiazepine overlap). Among all prescriptions and high-risk prescriptions, the authors calculated the proportion accounted for by high-volume dentists -- those with prescription counts in the 95th percentile or higher. Using logistic regression, the characteristics associated with being a high-volume dentist were identified.

      Results

      In 2019, a total of 141,345 dentists accounted for 10,736,743 opioid prescriptions dispensed to patients aged >12 years; 4,242,634 (39.5%) were high-risk prescriptions. The 7,079 high-volume dentists, a group representing 5.0% of the 141,345 dentists, accounted for 46.9% of all prescriptions and 47.5% of high-risk prescriptions. Male sex, younger age, non‒Northeast location, and specialization in oral and maxillofacial surgery were associated with a higher risk of being a high-volume dentist.

      Conclusions

      In 2019, high-volume dentists accounted for almost half of dental opioid prescriptions and high-risk prescriptions. Quality improvement initiatives targeting these dentists may be warranted.
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