| abuse

Opioids and Wisdom Tooth Extraction: More Risk Than Benefit

Study Finds Higher Propensity for Abuse in Patients Who Take Opioids Following Extraction

Younger patients who filled a prescription for opioids when undergoing wisdom tooth extraction were 2.7 times more likely to fill at least 2 more prescriptions in the following year, according to findings from a new study conducted in association with the Michigan Opioid Prescribing and Engagement Network, or Michigan OPEN. Patients in their late teens or twenties were at highest risk of aberrant behavior, in contrast to younger teens, the researchers report. Some 3.5 million extraction procedures are performed each year in the US, and opioids are routinely prescribed for postsurgical pain. Lead author Calista Harbaugh, MD, research fellow and surgical resident at University of Michigan, commented, “Until now, we haven’t had data on the long-term risks of opioid use after wisdom tooth extraction. 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.” The findings are reported in a research letter in the current issue of JAMA.

The study examined insurance records of patients who were opioid naive prior to their wisdom tooth extraction. Of 56,686 patients who filled an opioid prescription, 1.3% progressed to “persistent” opioid use, as compared to 0.5% repeat users in 14,256 patients who did not receive opioids at the time of their surgery. The authors note that although the percentage associated with misuse is low, when applied to the high number of extractions performed, it nonetheless represents a high level of risk overall. Senior author Chad Brummett, MD, codirector of Michigan OPEN, remarked, “These are some of the first data to the show long-term ill effects of routine opioid prescribing after tooth extractions. When taken together with the previous studies showing that opioids are not helpful in these cases, dentists and oral surgeons should stop routinely prescribing opioids for wisdom tooth extractions and likely other common dental procedures.”

The Michigan OPEN project will be explored in greater detail at PAINWeek 2018 next month in Las Vegas, with Dr. Brummett’s presentation, The Role of Acute Care in the Opioid Epidemic, part of a new course track exploring issues in acute pain management.

Read about the study and recommendations.

The journal abstract may be read here.