Despite meaningful progress in reducing opioid prescribing, American dentists continue to give powerful painkillers to their patients at rates that far exceed those of other developed countries, according to a new study published in JAMA Network Open.
The research, led by investigators from the University of Michigan Medical School and the University of New South Wales, analyzed dental opioid prescription trends across the U.S., Puerto Rico, Canada, France, Australia, Germany, and the Netherlands.
Between 2021 and 2024, the rate of patients filling opioid prescriptions written by dentists fell 27% in U.S. states and 10% in Puerto Rico, with double-digit declines also recorded in Canada, France, Australia, and Germany. While those figures reflect genuine movement in the right direction, the U.S. still recorded the highest dental opioid prescription fill rate of all countries studied by the end of 2024, though it had narrowed the gap with Canada.
The scale of the disparity is notable. In the Netherlands in 2024, just 83 opioid prescriptions tied to dental care were filled per 100,000 residents. In the U.S., that number was 2,022 -- roughly 24 times higher.
Lead author Dr. Kao-Ping Chua, PhD, an associate professor of pediatrics at the University of Michigan Medical School, said the data point to a prescribing culture that has not fully caught up with the evidence.
"Our study shows that the U.S. dental opioid dispensing rate is decreasing but remains high by international standards," Chua said. "This finding suggests that some U.S. dentists are still overprescribing opioids."
The stakes extend beyond pain management. Dental guidelines increasingly encourage clinicians to steer patients toward non-opioid alternatives because of the documented risks of using opioids, including opioid use disorder, accidental poisoning, or overdose. Dental procedures represent an individual's common first exposure to prescription opioids, particularly for younger patients.
Chua and his colleagues have previously shown that U.S. dental opioid prescribing dropped 45% between 2016 and 2022, though progress slowed following the onset of the COVID-19 pandemic. Even at that reduced 2022 rate, U.S. prescribing was four times that of the 2016 rate in the United Kingdom.
The study was published in JAMA Network Open and funded in part by the U.S. National Institute on Drug Abuse and the Australian National Health and Medical Research Council.
