Can opioids prescribed for wisdom tooth extraction lead to long-term drug use?

August 29, 2018

New research shows that young people who filled an opioid prescription immediately before or after wisdom tooth surgery were nearly three times as likely to still be filling opioid prescriptions months later.

While more awareness is being spread about opioid abuse, the opioid epidemic remains a significant problem in the United States. Fortunately, the percentage of opioid prescriptions prescribed by dentists has fallen to 6.4 percent as of 2012, but the fact remains that dentists are typically one of the first medical professionals to prescribe opioids to teens and young adults for the treatment of acute pain, such as wisdom tooth removal. And according to new research, young people who fill an opioid prescription after wisdom tooth extraction may set themselves up for long-term opioid use.

Researchers at the Michigan Opioid Prescribing Engagement Network (Michigan OPEN) at the University of Michigan used insurance data to focus on young people who were “opioid naive,” meaning they hadn’t had an opioid prescription in the six months before their wisdom teeth extraction and who hadn’t had any other procedures requiring anesthesia in the following year. The data came from employer-based insurance plans, available through the Truven MarketScan database.

The team of researchers discovered that 1.3 percent of 56,686 wisdom tooth patients who filled their opioid prescription between 2009 and 2015 went on to persistent opioid use. The researchers defined persistent opioid use as two or more prescriptions filled in the next year written by any provider for any reason. The team also determined that young people ages 13 to 30 who filled an opioid prescription immediately before or after they had their wisdom teeth removed were nearly three times as likely as their peers to still be filling opioid prescriptions weeks or months later. Patients in their late teens and twenties had the highest odds of persistent opioid use compared to patients in middle school or high school.

“We found that filling an opioid prescription increased the odds of developing new persistent use nearly three-fold, isolated from other patient factors such as age, tooth impaction and health conditions,” says Calista Harbaugh, MD, a Michigan OPEN research fellow and lead author of the study. “With 3.5 million healthy young people having their wisdom teeth pulled each year, this translates to nearly 50,000 young people who could develop new persistent opioid use each year because of the opioid prescription alone. This is an important step in understanding the unintended effects of prescribing when no prescription may be indicated at all.”

Harbaugh says the team of researchers had previously discovered that about 5 percent of teens and young adults who don’t take opioids but then receive a prescription after an operation develop new persistent opioid use where opioids are used far longer than expected for recovery. This time, the team decided to focus its attention on the effects specifically after wisdom tooth extraction since there’s evidence that shows that opioids are no more effective for pain control than non-opioid anti-inflammatory medications when used in combination. By examining this population, Harbaugh says the team could look at the effects of opioid prescribing after wisdom tooth removal.

“The death toll from the opioid epidemic has continued to rise each year. Many efforts importantly focus on prevention of opioid-related overdose among people who already use opioids. There is another important population of people who do not already take opioids, who will receive an opioid prescription for a surgery or dental procedure, and may go on to new chronic opioid use,” she says.

“In addition, 72 percent of opioids prescribed for surgery go unused and these overprescribed medications are sources of diversion and misuse. At Michigan OPEN, we have focused our efforts on primary prevention of new chronic opioid use, overprescribing that can lead to diversion and disposal efforts to remove opioid sources from the community.”

Because of the growing opioid overdose crisis, the American Dental Association earlier this year announced a new policy to combat the opioid epidemic. The policy in part supports mandatory continuing education in prescribing opioids and other controlled substances.

“Children are in a vulnerable time in terms of risk of persistent use and addiction to opioids,” says Dr. Romesh Nalliah, clinical associate professor and director of pre-doctoral clinical education at the University of Michigan and a co-author of the study. “Additionally, dentists are the most prolific prescribing to the age group 10-19 and every prescription should be considered very thoughtfully and should be a last resort after all other pain management strategies have been ruled out.”

The team of researchers at Michigan OPEN is currently studying this topic further by speaking with patients and parents about their wisdom tooth extraction experience and how many opioid pills they actually took. The team hopes this will allow them to create evidence-based prescribing guidelines.

The full study, titled "Persistent Opioid Use After Wisdom Tooth Extraction," was published in the Journal of the American Medical Association.