Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois.
Am J Prev Med. 2020 Apr;58(4):473-486. doi: 10.1016/j.amepre.2019.11.006. Epub 2020 Feb 4.
Dentists prescribe 1 in 10 opioid prescriptions in the U.S. When opioids are necessary, national guidelines recommend the prescription of low-dose opioids for a short duration. This study assesses the appropriate prescribing of opioids by dentists before guideline implementation.
The authors performed a cross-sectional analysis of a population-based sample of 542,958 U.S. commercial dental patient visits between 2011 and 2015 within the Truven Health MarketScan Research Databases (data analysis October 2018‒April 2019). Patients with recent hospitalization, active cancer treatment, or chronic pain conditions were excluded. Prescription opioids were ascertained using pharmacy claims data with standardized morphine equivalents and recorded days' supply. Appropriate prescribing was determined from the 2016 Centers for Disease Control and Prevention guidelines for pain management based on a recommended 3 days' supply of opioid medication and anticipated post-procedural pain.
Twenty-nine percent of prescribed opioids exceeded the recommended morphine equivalents for appropriate management of acute pain. Approximately half (53%) exceeded the recommended days' supply. Patients aged 18-34 years, men, patients residing in the Southern U.S., and those receiving oxycodone were most likely to have opioids prescribed inappropriately. The proportion of opioids that exceed the recommended morphine equivalents increased over the study period, whereas opioids exceeding the recommended days' supply remained unchanged.
Between 1 in 4 and 1 in 2 opioids prescribed to adult dental patients are overprescribed. Judicious opioid-prescribing interventions should be tailored to oral health conditions and dentists.
在美国，牙医开具的阿片类药物处方占 10%。当需要使用阿片类药物时，国家指南建议开具低剂量阿片类药物，使用时间应尽量短。本研究评估了指南实施前牙医开具阿片类药物的情况。
作者对 2011 年至 2015 年期间在美国 Truven Health MarketScan 研究数据库中的 542958 例基于人群的美国商业牙科患者就诊进行了横断面分析（数据分析于 2018 年 10 月至 2019 年 4 月进行）。排除了近期住院、正在接受癌症治疗或患有慢性疼痛疾病的患者。通过使用药房索赔数据确定处方阿片类药物，数据中包含标准化吗啡当量和记录的供应天数。根据 2016 年疾病控制与预防中心发布的疼痛管理指南，使用建议的 3 天阿片类药物供应量和预期术后疼痛来确定适当的处方。
29%的处方阿片类药物超过了急性疼痛管理的推荐吗啡当量。大约一半（53%）的药物供应天数超过了推荐的天数。18-34 岁的患者、男性患者、居住在美国南部的患者和接受羟考酮治疗的患者最有可能开具不适当的阿片类药物。超过推荐吗啡当量的阿片类药物比例在研究期间有所增加，而超过推荐供应天数的阿片类药物比例保持不变。
在开具给成年牙科患者的阿片类药物中，有 1/4 到 1/2 是开具过量的。应根据口腔健康状况和牙医的特点，采取明智的阿片类药物处方干预措施。
