Wisdom tooth surgery increases risk for long-term use of opioids

Getting wisdom teeth pulled often comes with a side of potent painkillers to help the discomfort.

And a new research report published in the Journal of the American Medical Association on Tuesday warns those opioid drug prescriptions associated with the common dental procedure may be leading to long-term use among young people.

Researchers from the University of Michigan’s Institute for Healthcare Policy and Innovation examined the national Truven MarketScan, a national employer insurance database, to focus on 56,686 wisdom tooth patients between 2009 and 2015.

Among young people ages 13 to 30, the study found those patients who filled their opioid prescription either immediately before or after having their wisdom teeth pulled were 2.7 times more likely than their peers to still be filling opioid prescriptions weeks or months later.

Teens and young adults who had a history of mental health concerns, such as depression, or chronic pain conditions were more at risk to go on to persistent use.

“Until now, we haven’t had data on the long-term risks of opioid use after wisdom tooth extraction,” said Calista Harbaugh, M.D., a U-M research fellow with the Michigan Opioid Prescribing and Engagement Network, or Michigan OPEN. “We now see that a sizable number go on to fill opioid prescriptions long after we would expect they would need for recovery and the main predictor of persistent use is whether or not they fill that initial prescription.” In all, about 1.3% who filled an opioid prescription went on to persistent opioid use, defined as two or more prescriptions. In comparison, less than a percent of the 14,256 wisdom tooth patients who didn’t fill a prescription went on to persistent opioid use.

The numbers may sound small, but is a much larger figure than it sounds because of how common wisdom tooth surgery is, Harbaugh said.

The study comes in the midst of an opioid crisis, with opioid overdoses accounting for more than 42,000 deaths in the U.S. in 2016, more than any previous year on record. The Department of Health and Human Services estimates 40% of opioid overdose deaths involved a prescription opioid.

In the report, the authors recommend dentists and oral surgeons stop routinely prescribing opioids, instead opting for non-opioid painkillers for their wisdom tooth patients. If pain is acute, they suggest prescribing less than the seven-day opioid supply which was recommended in March by the American Dental Association. That recommendation came around the same time the Centers for Disease Control and Prevention suggested primary care providers avoid prescribing opioids when appropriate.

Moving forward, the Michigan OPEN team said they are studying wisdom teeth patients further by reaching out to patients and their parents about their experience and how many opioid pills they actually took to create evidence-based prescribing guidelines.

The group has previously released prescribing guidelines for other surgeries including mastectomies and appendectomies. Other health systems, such as Johns Hopkins and Dartmouth-Hitchcock have also begun creating surgery specific prescribing guidelines for opioids.

https://bit.ly/2AWqiie