SA3 - Opioid Prescriptions to Opioid-Naïve Patients by Oral and Maxillofacial Surgeons in Massachusetts 2012-2022

Abstract:

Background: Oral-maxillofacial surgeons (OMSs) are frequent prescribers of opioid analgesics for post-operative pain. Many OMS patients are young healthy adults who are opioid-naïve.[1,2] Studies have shown that prescription opioids to opioid-naïve populations can increase the risk of subsequent misuse.[3] Furthermore, studies have reported that the majority of opioids prescribed by OMSs remain unused, which can increase the risk of opioid diversion.[1,2] As such, this study aimed to characterize trends in opioid prescribing to opioid-naïve patients by OMSs in Massachusetts over the last decade.

Methods: This retrospective cohort study used the Massachusetts Prescription Monitoring Program database to identify Schedule II and III opioid prescriptions by providers with specialty of “oral and maxillofacial surgery” from 2012-2022. The primary predictor variable was patient opioid-naïve status, defined as not having filled an opioid prescription in the prior 12 months. Outcome variables included morphine milligrams equivalent (MME) per prescription and days’ supply per prescription. Each year, the first prescription filled by opioid-naïve patients was counted in the data, whereas all prescriptions filled by non-naïve patients were included since it was not possible to identify the index prescription. Descriptive statistics and linear regressions were used to analyze differences in prescriptions to opioid-naïve and non-naive patients each year and throughout the study period.

Results: The data included a total of 918,945 prescriptions to 679,616 opioid-naïve patients and 187,304 non-naïve patients from 2012 to 2022. Compared to non-naïve patients, the opioid-naïve cohort had a slightly lower proportion of females (P≤0.01 for all years) and were significantly younger (P≤0.01 for all years). During the study period, opioid-naïve patients received lower MME per prescription than non-naïve patients (P≤0.05 except in 2012, 2016, 2017). Opioid-naïve patients also received fewer days’ supply per prescription than their non-naïve counterparts, though the highest difference was only 0.2 days in 2013, 2021, and 2022 (p≤0.01). MME per prescription (β=-7.60, 95% CI: -8.16, -7.04; R2=0.70) and days’ supply per prescription (β=-0.11, 95% CI: -0.12, -0.10; R2=0.75) decreased at a similar rate throughout the study period for both opioid-naïve and non-naïve patients

Conclusions: OMSs in Massachusetts predominantly prescribed opioids to opioid-naïve patients. Prescriptions to opioid-naïve patients were generally lower in dosage and duration compared to that to non-naïve patients. These differences have remained consistent throughout the study period with an overall decrease in dosage and duration of opioid prescriptions to all patients in Massachusetts by OMSs from 2012 to 2022. References1. Bousquet B, Green MA, Caillouette CN, Simon J, Padwa BL, Resnick CM: How Much Opioid Medication Do Patients Need After Orthognathic Surgery? Journal of Oral and Maxillofacial Surgery 80: 1174, 2022.2. Resnick CM, Calabrese CE, Afshar S, Padwa BL: Do Oral and Maxillofacial Surgeons Over-Prescribe Opioids After Extraction of Asymptomatic Third Molars? J Oral Maxillofac Surg 77: 1332, 2019.3. Schroeder AR, Dehghan M, Newman TB, Bentley JP, Park KT: Association of Opioid Prescriptions From Dental Clinicians for US Adolescents and Young Adults With Subsequent Opioid Use and Abuse. JAMA Intern Med, 2018.

Table 1. Demographics of opioid-naïve and non-naïve patients prescribed opioids by OMS in Massachusetts 2012-2022.
Table 2. Initial opioid prescriptions to opioid-naïve patients compared to prescriptions to non-naïve patients in Massachusetts by OMSs 2012-2022.
Figure 1. Initial opioid prescriptions to opioid-naïve patients compared to prescriptions to non-naïve patients in Massachusetts by OMSs 2012-2022.