Dental pain a top reason Medicaid patients given opioids

Approximately 17% of Medicaid recipients who are prescribed opioids to manage pain receive them for dental reasons, according to a new study. Overall, about half of the Medicaid opioid prescriptions are for either orthopedic or dental-related reasons.

Additionally, emergency department healthcare providers are more likely than their colleagues to prescribe opioids, the study authors reported in the American Journal of Preventive Medicine (August 1, 2019).

These findings are important because low-income populations in the U.S. are disproportionately prescribed more opioids than other population groups, the reseachers noted.

To investigate opioid prescription patterns among U.S. Medicaid recipients diagnosed with acute or chronic pain, they assessed medical and pharmacy claims data filed between 2013 and 2015 from the Truven MarketScan Medicaid Database from 13 U.S. states.

Their study included any Medicaid patient who visited an outpatient healthcare facility and received an opioid prescription within 14 days of a diagnosis related to back, neck, joint, or orthopedic pain, headaches, dental conditions, or otorhinolaryngologic conditions. More than half of these patients were age 30 or older and almost 15% were age 18 or younger. About 65% were women, and almost 60% identified as non-Hispanic white.

Among the nearly 16.4 million Medicaid claims initiated, approximately 5.7 million were for pain management. Almost a million (18.8%) of these patients with pain-related conditions filled opioid prescriptions following diagnoses, the researchers noted.

The largest number of patients (34.8%) received opioids for orthopedic pain, followed by dental pain (17.3%). Less than 2% were given opioids for ear, nose, and throat (ENT)-related pain.

The gender and race/ethnicity of patients and the type of healthcare provider prescribing affected the prescription patterns, according to the findings. Female patients were more likely than male patients to receive opioids for dental-related diagnoses. Non-Hispanic whites were more likely to receive an opioid prescription than Hispanics for all the diagnoses evaluated, and Hispanics also were less likely to receive an opioid prescription than the other race and ethnic groups.

Emergency department healthcare providers prescribed the highest percentage of opioids for acute pain conditions, such as dental (almost 52%) and orthopedic (almost 50%). General practitioners prescribed the most opioid prescriptions for chronic pain.

Additionally, emergency department providers and general practitioners account for most of the opioid prescriptions for orthopedic (almost 79%), ENT (nearly 75%), dental (74%), headache (almost 73%), and back pain (nearly 70%).

Though the findings provide valuable information that can be used to improve public health, there were some study limitations, such as its cross-sectional nature, which prevented the authors from investigating causal relationships. Also, as no geographic information was provided to maintain patient confidentiality, this limited the researchers' abilities to assess how different state policies concerning Medicaid enrollment may have affected the findings. Also, data for October, November, and December 2015 were unavailable.

The authors concluded that this research may help prescribers limit use of these pain relief medications.

"Understanding opioid prescribing patterns is important for generating hypotheses and identifying research needs that provide information leading to the development of guidelines and policies to prevent the inappropriate use of this important class of medication and improve public health," wrote the authors, led by Chandrashekar Janakiram, MDS, PhD, of the National Library of Medicine in Bethesda, MD.