One in 10 older dental patients inappropriately prescribed opioids

 

Combinations with psychiatric meds among most dangerous

A new study by researchers at the University of Illinois Chicago and the University of Pittsburgh suggests that a significant proportion of older patients receiving opioids at dental visits also use psychotropic medications -- a potentially harmful combination. Their findings are published in the journal Pharmacotherapy.

Rates of polypharmacy, or taking multiple medications, are high among older adults who are more likely to be managing more than one health issue at any given time. Psychotropic medications that act on the central nervous system, such as antianxiety or antidepressant medications, are especially dangerous if taken with opioids because they can interact with each other and have negative effects.

"Some of the most concerning negative outcomes of these combinations include overdosing on opioids or falling, which can necessitate a visit to the hospital, which in itself carries greater risk for older adults," said Gregory Calip, associate professor of pharmacy systems, outcomes and policy at the UIC College of Pharmacy and corresponding author on the paper.

The researchers looked at medical, dental and pharmacy claims data from 40,800 older adult dental patients who visited a dentist between 2011 and 2015 and were prescribed opioids. The data was from the IBM Watson MarketScan databases.

The average age of the patients included in the study was 69 years old and 45% were female. Of these patients, 10% were taking medications that are associated with increased risks for harm with opioid prescriptions.

There were a total of 947 hospitalizations or emergency room visits among these patients.

The researchers found that among patients prescribed opioids by their dentist, 1 in 10 were already taking a prescription medication that should not be prescribed with opioids.

They also found that patients inappropriately prescribed an opioid medication combination by their dentist were 23% more likely to be hospitalized or visit an emergency department in the 30 days after the dental visit where they were prescribed an opioid, compared with dental patients who were not prescribed an opioid medication.

"Dentists are among the top prescribers of opioids," said Katie Suda, professor of medicine at the University of Pittsburgh School of Medicine and principal investigator of the study. "It seems that the increased messaging regarding limiting opioid prescriptions has been aimed primarily at medical physicians and not tailored to other specialist providers, including dentists. This can have dire consequences. As we saw in our study, opioid interactions with other medications was likely responsible for the significant rise in emergency room visits and hospitalizations."

"Although the percentage of opioids prescribed by dentists has decreased in the last 20 years, dentists must continue interprofessional collaboration with primary care physicians, pharmacists, and other health care providers to address devastating and preventable drug interactions affecting vulnerable patients who look to them for safe and compassionate care," said Dr. Susan Rowan, executive associate dean and associate dean for clinical affairs at the UIC College of Dentistry.