This is my second post of the ongoing studies of prescription opioid therapy in dentistry through a joint effort between the University of Michigan Schools of Medicine and Dentistry and their collaboration through the Michigan Open Prescribing Engagement Network. In my first installment, I reviewed and provided some criticism of research regarding the risk of overdose in patients and their families.
This post pertains to an article entitled “Persistent Opioid Use Associated With Dental Opioid Prescriptions Among Publicly and Privately Insured US Patients, 2014 to 2018” appearing on the JAMA Open Network on April 16, 2021 and is written by Kao-Ping Chua MD, PhD and Romesh Nalliah, DDS et al. In their big data study these researchers noted that publicly insured patients (Medicaid) are twice as more likely to develop persistent opioid use after an initial appointment (presumedly an evaluation) than their privately insured counterparts.
In an interview with Helio News, Chua is quoted and suggests that dentists are more likely to provide an opiate prescription to Medicaid patients than to treat the problem, depending upon circumstances:
“Specifically, if a Medicaid patient with dental pain is unable to undergo the procedure that fixes the underlying problem, they might be written an opioid prescription instead,”Interview with Kao-Ping Chua MD, PhD, Helio News
Chua goes on to suggest because dental practitioners appear to be less diligent than their physician counterparts when concerned with appropriate opiate prescribing practices that primary care providers should intervene, develop their own network of dental providers with a proven history of appropriate patient management, and recommend accordingly:
“First, if they see a patient with a dental problem, they can recommend dentists who believe in judicious opioid prescribing,” he said. “Second, primary care providers who know their patient is about to have a dental procedure can counsel the patient on the risks of opioid prescriptions, highlight the importance of taking opioids only as prescribed, and give instructions on how to safely dispose of unused opioids.”Interview with Kao-Ping Chua MD, PhD, Helio News
Dentistry most definitely has some fences to mend, but we are NOT responsible for the overwhelming majority of patients who have become addicted to narcotics through pill mills, chronic pain clinics, surgical procedures, and others. Dentistry is NOT a healthcare subdomain of medicine and to suggest that average physicians should wade in on a subject they know absolutely nothing about is not only irresponsible but ridiculous if not unethical or illegal.
It isn’t even necessary to conduct a parallel study to investigate persistent opioid use with a physician cohort, for example, in chronic pain patients during the same time period. The results of such study would far exceed what is cited here. Further, though Dr Chua states opiates are often unnecessary in the dental domain, nevertheless it is a well known fact that opiates are ever more so unnecessary and ineffective against chronic pain, yet we know they have been prescribed – clearly in abundance. The reader does not need to be reminded that dentists do not treat chronic pain, nor do they run pill mills. So what is the point here? For these reasons there would appear to be a bias among these investigators and it would seem they are allowing it to influence the design of their studies. In my previous blog post regarding the ongoing UM studies, I concluded:
“It’s in the public’s best interest that all health care providers are more judicious in their opiate prescribing behaviors and it leads one to question the authors objectives. In the opinion of this author, to focus only on Dentistry is to ignore the impact of other healthcare domains to public health.”David MH Lambert, DDS
Nothing else to see here…