Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr VA Hospital, Hines, Illinois, USA.
Division of Hospital Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA.
J Public Health Dent. 2023 Jun;83(2):136-146. doi: 10.1111/jphd.12560. Epub 2023 Feb 17.
Opioids prescribed by dentists have been associated with serious adverse events, including opioid-related overdose and mortality. However, the downstream outcomes of opioids prescribed by dentists to Veterans who are at high risk for opioid misuse and overdose have yet to be determined.
This was a national cross-sectional analysis of opioids associated with dental visits within the Veterans Health Administration from 2015 to 2018. Overprescribing was defined per guidelines as >120 morphine milligram equivalents (MME) or >3 days supply. The association of dental visit and patient characteristics was modeled separately for opioid-related poisoning and all-cause mortality using logistic regression.
Of 137,273 Veterans prescribed an opioid by a dentist, 0.1% and 1.1% were associated with opioid-related poisoning and mortality, respectively. There was no difference in opioid poisoning within 6 months for Veterans with opioid prescriptions >120 MME (aOR = 1.25 [CI: 0.89-1.78]), but poisoning decreased in Veterans prescribed opioids >3-days supply (aOR = 0.68 [CI: 0.49-0.96]). However, Veterans with opioids >120 MME were associated with higher odds of mortality within 6 months (aOR = 1.17 [95% CI: 1.05-1.32]) while there was no difference in prescriptions >3-days supply (aOR = 1.12 [CI: 0.99-1.25]).
Serious opioid-related adverse events were rare in Veterans and lower than other reports in the literature. Since nonopioid analgesics have superior efficacy for the treatment of acute dental pain, prescribing opioid alternatives may decrease opioid-related poisoning. Strategies for dentists to identify patients at high risk should be incorporated into the dental record.
牙医开具的阿片类药物与严重不良事件有关，包括阿片类药物相关的过量和死亡。然而，牙医为有阿片类药物滥用和过量风险的退伍军人开具的阿片类药物的下游结果尚未确定。
这是一项 2015 年至 2018 年期间在退伍军人健康管理局内与牙科就诊相关的阿片类药物的全国性横断面分析。根据指南，过量开具定义为 >120 吗啡毫克当量（MME）或 >3 天供应量。使用逻辑回归分别对牙科就诊和患者特征与阿片类药物相关中毒和全因死亡率进行建模。
在 137273 名被牙医开具阿片类药物的退伍军人中，分别有 0.1%和 1.1%与阿片类药物相关中毒和死亡有关。对于阿片类药物处方 >120MME 的退伍军人，6 个月内的阿片类药物中毒没有差异（比值比[aOR] = 1.25 [CI：0.89-1.78]），但阿片类药物处方 >3 天供应量的退伍军人中毒减少（aOR = 0.68 [CI：0.49-0.96]）。然而，阿片类药物处方 >120MME 的退伍军人在 6 个月内死亡的可能性更高（aOR = 1.17 [95% CI：1.05-1.32]），而处方 >3 天供应量的退伍军人则没有差异（aOR = 1.12 [CI：0.99-1.25]）。
在退伍军人中，严重的阿片类药物相关不良事件很少见，低于文献中的其他报告。由于非阿片类镇痛药在治疗急性牙痛方面具有更好的疗效，因此开具阿片类药物替代品可能会减少阿片类药物相关中毒。应将牙医识别高风险患者的策略纳入牙科记录。
