Opioid Prescriptions for Dental and Non-dental Visits in the ED-2015-2016 NHAMCS

Objectives: Prescription drug abuse and overdose has become a growing epidemic and a public health concern in the US. This study utilized the latest data from 2015-16 National Hospital Ambulatory Medical Care Survey (NHAMCS) and compared factors associated with opioid and non-opioid analgesic prescriptions in the Emergency Departments (ED) for dental-related and other visits.
Methods: Dental visits were identified using patient’s reported reasons for visit, including symptoms of teeth and gums, toothache, gum pain, bleeding gums, dental abscess and dental cavities. Analgesic prescription was identified using prescription data and categorized as opioid or non-opioid analgesic. Correlates included age, gender, race/ethnicity, region, payer, time of visit, provider type, triage level, hospital location and pain level. A preliminary analysis was conducted and p≤0.05 was considered statistically significant.
Results: There were approximately 4 million dental visits and 278 million other visits to ED in 2015-16. Those with dental visits were more likely to be female, between 18-44 years, NH Whites, Medicaid beneficiaries, reported severe pain and categorized at a semi-urgent triage level. Of all dental visits, 58.5% received an opioid prescription and 18.2% received an non-opioid analgesic prescription. Among non-dental visits, 23.2% received an opioid and 22.6% received a non-opioid analgesic prescription. This pattern of high opioid prescription remained consistent across the various patient and clinical characteristics for dental visits. Among dental visits, 69.5% of those with severe pain were prescribed an opioid in contrast with 43% among non-dental visits. On the other hand, 24% of those with severe pain among non-dental visits received a non-opioid analgesic while only 18% of those with severe pain among dental visits received a non-opioid analgesic prescription.
Conclusions: Our findings are relevant to oral health and ED stakeholders including policy-makers, and highlight the need for provider education on alternatives to opioid prescriptions, specifically for dental-related visits.