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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