Persistent Opioid Use Associated With Dental Opioid Prescriptions Among Publicly and Privately Insured US Patients, 2014 to 2018 (original) (raw)

Persistent opioid use (POU) occurs when patients who receive opioid prescriptions after procedures continue to use opioids after acute pain typically resolves. 1-3 In dentistry, the risk of POU has been assessed among privately insured patients. 2,3 Whether the risk of POU differs among publicly insured patients is unknown. The goal of this study was to compare the risk of POU among privately and publicly insured dental patients aged 13 to 64 years in the United States. Methods This retrospective cohort study used data from the 2014-2018 IBM MarketScan Dental, Commercial, and Multi-State Medicaid research databases. The Dental database contains dental claims from 1 million to 1.5 million nonelderly patients with employer-sponsored dental insurance; most claims can be linked to medical and pharmacy claims in the Commercial database. The Multi-State Medicaid database includes dental, medical, and pharmacy claims from 10 million to 12 million patients in several unidentified states. Because the data were deidentified, the University of Michigan Institutional Review Board deemed this study exempt from institutional review board review and patient informed consent. The study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline. Patients aged 13 through 64 years who had dental procedures between July 1, 2014, and December 31, 2017, were included in the study. Analyses were limited to each patient's earliest procedure, the date of which was the index date. We excluded the following groups of patients: those lacking continuous enrollment during the 180 days before through 365 days after the index date, those who were not opioid naive, those who had dental procedures before the index date, and those who had subsequent surgical or dental procedures. The exposure variable was set to 1 if there were 1 or more dispensed opioid prescriptions between 7 days before and 3 days after the index date (initial prescription). 2 Persistent opioid use was defined as 1 or more dispensed opioid prescriptions 4 to 90 days after the index date and 1 or more prescriptions 91 to 365 days after the index date. 2 Using logistic regression, we modeled the occurrence of POU as a function of the exposure, payer type, and their interaction. Models controlled for demographic and clinical characteristics. We calculated the average marginal effect (AME) of the exposure-the change in risk of POU if all patients did and did not have initial prescriptions-overall and by payer type. SAS version 9.4 (SAS Institute Inc) and Stata 14.2 MP (StataCorp) were used for statistical analysis. Two-sided hypothesis tests were conducted with α = .05. Results A total of 1 691 878 patients were included in the study sample (Figure). Among these patients, 934 883 (55.3%) were female, 756 995 (44.7%) were male, and the mean (SD) age was 34.7 (16.3) years (Table). Among these patients, 38.5% were aged 13 to 25 years, and 37.0% were publicly insured; almost a third of patients (31.3%) had 1 or more initial prescriptions. The risk of POU was Author affiliations and article information are listed at the end of this article.