UK dentists 37 times less likely to prescribe opioids than dentists in US

  • New study analysed dental prescription patterns in the UK and US in 2016 – a peak year in the US opioid crisis
  • 1.4 million opioid prescriptions were made in the US compared to only 28,000 in the UK
  • Study shows dentists in the US prescribe higher potency opioids than are necessary to control dental pain
  • National guidelines for treating dental pain could help to address US opioid crisis

opioids

A new study has found UK dentists are 37 times less likely to prescribe opioids than dentists in the US.

The findings, published today (24 May 2019) in JAMA Network Open, suggest guidelines followed by UK dentists to prescribe non-steroidal anti-inflammatory drugs (NSAIDs) or paracetamol for dental pain management, rather than strong opioids, could be a potential method to address the opioid crisis in the US.

Conducted by researchers at the University of Sheffield and University of Illinois at Chicago (UIC), the study revealed dentists are among the top prescribers of opioids in the US, prescribing them in greater quantities and stronger opioids than are necessary to control dental pain. This increases the potential for opioid abuse.

A total of 22 per cent of all US dental prescriptions were for opioids compared to just 0.6 per cent of dental prescriptions in the UK. This finding remained even when adjusted for population size and number of dentists.

Martin Thornhill, Professor of Translational Research in Dentistry at the University of Sheffield and co-author of the study, said: “The high level of opioid prescribing in the US is shocking. Particularly, when there is good evidence that NSAIDs and acetaminophen are as good or better than opioids for treating dental pain and don’t cause the unpleasant side-affects, addiction and misuse problems associated with opioids.

“UK dentists manage exactly the same pain problems as their US colleagues and achieve high levels of patient satisfaction using NSAIDs and acetaminophen, without the need to resort to opioids.”

He added: “Unsurprisingly, more than half of opioids prescribed following tooth extraction in the US remain unused by patients. This means an estimated one million opioid pills a year can be diverted to other purposes, creating a huge potential for opioid misuse.”

In the UK the Dental Practioners Formulary, which is a list of medicines approved for use by dentists – restricts opioid prescribing to the codeine derivative dihydrocodeine which is of much lower strength than opioids regularly prescribed in the US.

In order to study dental provider opioid prescribing practices in the two countries, Professor Thornhill and colleagues at UIC analysed nationally-representative databases from both countries. These showed prescriptions dispensed from retail pharmacies, including community and mail service pharmacies, and outpatient clinic pharmacies in 2016, which is considered to be a peak point in the US opioid crisis.

Corresponding author of the study Dr Katie Suda, Associate Professor of Pharmacy Systems, Outcomes and Policy at UIC, said: “To see such a difference among two groups of dentists in countries with similar oral health and use of dentists is an indicator that opioid prescribing practices in the US 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 US should be a priority and should be included as part of more comprehensive judicious opioid prescribing strategies."

The research also found that US dentists prescribed a much wider range of opioid agents, where as dentists in England only prescribed one. In the US, the most commonly prescribed opioids were hydrocodone-based, followed by codeine, oxycodone and tramadol.

One in 10 opioids prescribed by US dentists were opioids with a high potential for abuse and diversion, such as oxycodone and long-acting opioids which are not prescribed in the UK.

Dr Susan Rowan, Co-author and Executive Associate Dean and Associate Dean for Clinical Affairs at the UIC College of Dentistry, said: "Dentists need to be part of the opioid conversation.

"It is common for people to overlook dental issues until pain becomes severe and major interventions are needed. Pain killers are often an essential part of dental care and provider flexibility in choice is important, but this study shows us there is room for dental providers to contribute to and inform abuse reduction programs.

"This data provides substantial information and should be a wake-up call to individual dental practices and collaborative organizations of dental care providers to push the envelope towards greater efforts to reduce opioid prescribing or patients' potential for abuse.”

The research was supported by the Agency for Healthcare Research and Quality (R01HS25177) and the National Centre for Advancing Translational Sciences (UL1TR002003).

Additional co-authors include Dr Gregory Calip and Hajwa Kim of UIC, Dr Michael Durkin of Washington University, Dr Walid Gellad of the University of Pittsburgh and Dr Peter Lockhart of Carolinas Medical Center.

The University of Sheffield’s School of Clinical Dentistry is focussed on making a substantial and positive impact on oral health and well-being by combining excellent education with world-leading research. The University of Sheffield is one of the top 10 Russell Group universities for research output, and the School of Clinical Dentistry offers students research-led teaching, based on the latest findings.

The department strives to provide the best learning facilities possible, such as a new virtual reality simulation suite.

The combination of classroom study, clinical skills, laboratories and patient clinics enables students to develop the full range of skills and knowledge needed for dentistry.

The School of Clinical Dentistry has a close working relationship with the Charles Clifford Dental Hospital, a specialist facility where the majority of the department’s clinical teaching takes place. Students are given the opportunity of outreach placements where they provide care across South Yorkshire and gain experience to help them transition into employment.

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Amy Huxtable
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The University of Sheffield
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