Objectives: Dentists contribute to the prevailing opioid epidemic in the United States. Among the Medicaid population, very little is known about opioid prescribing by dentists, although Medicaid beneficiaries are disproportionately affected by the opioid epidemic.
Methods: We conducted a retrospective cohort study of Washington State Medicaid beneficiaries using claims data (2014 and 2015). The primary outcome was the proportion of dental visits associated with an opioid prescription. We also examined the relationship between receiving an opioid prescription and the type of dental visit or a history of prior high risk prescription use.
Results: 126,660 (10.3%) of all dental visits were associated with opioid prescriptions, most of which were invasive (66.9%). However, non-invasive dental visits, and visits for beneficiaries with a history of prior high risk prescription use, were associated with significantly higher mean days’ supply and mean quantity of opioids prescribed. The multivariate logistic regression showed that the probability of having an opioid-associated dental visit increased by 35.6 percentage points (pp) when the procedures were invasive, or 11.1pp, when the beneficiary had a history of prior high risk prescription use.
Conclusions: Dentists must exercise caution when prescribing opioids during invasive visits and to patients with prior high risk prescription use. The reasons for the higher dosage and duration of opioid prescriptions associated with non-invasive visits need to be further examined. Compared to a published study of privately-insured patients, Washington State Medicaid beneficiaries did not have a higher mean days’ supply, mean quantity prescribed, or mean daily MMEs of opioid prescriptions.