Impact of Hydrocodone Rescheduling on Dental Prescribing of Opioids

C. H. Yan; C. C. Hubbard; T. A. Lee; L. K. Sharp; C. T. Evans; G. S. Calip; S. A. Rowan; J. C. McGregor; W. F. Gellad; K. J. Suda

doi:10.1177/23800844221102830

Impact of Hydrocodone Rescheduling on Dental Prescribing of Opioids

C. H. Yan^*, C. C. Hubbard, T. A. Lee, L. K. Sharp, C. T. Evans, G. S. Calip, S. A. Rowan, J. C. McGregor, W. F. Gellad, K. J. Suda

^*Corresponding author for this work

Preventive Medicine

Research output: Contribution to journal › Article › peer-review

1 Scopus citations

Abstract

Introduction: In the United States, dentists frequently prescribe hydrocodone. In October 2014, the US Drug Enforcement Administration rescheduled hydrocodone from controlled substance schedule III to II, introducing more restricted prescribing and dispensing regulations, which may have changed dental prescribing of opioids. Objective: The study aim was to evaluate the impact of the hydrocodone rescheduling on dental prescribing of opioids in the United States. Methods: This was a cross-sectional study of opioids prescribed by dentists between October 2012 and October 2016, using the IQVIA Longitudinal Prescription Dataset. Monthly dentist-based opioid prescribing rate (opioid prescription [Rx]/1,000 dentists) and monthly average opioid dosages per prescription (mean morphine milligram equivalent per day [MME/d]) were measured in the 24 mo before and after hydrocodone rescheduling in October 2014 (index or interruption). An interrupted time-series analysis was conducted using segmented ordinary least square regression models, with Newey–West standard errors to handle autocorrelation. Results: Dentists prescribed 50,412,942 opioid prescriptions across the 49 mo. Hydrocodone was the most commonly prescribed opioid pre- and postindex (74.9% and 63.8%, respectively), followed by codeine (13.8% and 21.6%), oxycodone (8.1% and 9.5%), and tramadol (2.9% and 4.8%). At index, hydrocodone prescribing immediately decreased by −834.8 Rx/1,000 dentists (95% confidence interval [CI], −1,040.2 to −629.4), with increased prescribing of codeine (421.9; 95% CI, 369.7–474.0), oxycodone (85.3; 95% CI, 45.4–125.2), and tramadol (111.8; 95% CI, 101.4–122.3). The mean MME increased at index for all opioids except for hydrocodone, and dosages subsequently decreased during the postindex period. Conclusion: Following the rescheduling, dentist prescribing of hydrocodone declined while prescribing of nonhydrocodone opioids increased. Understanding the impact of this regulation informs strategies to ensure appropriate prescribing of opioids for dental pain. Knowledge Transfer Statement: The study findings can be used by policy makers to make informed decisions in developing future risk mitigation strategies aimed to regulate opioid prescribing behaviors. Furthermore, dentist-specific resources and guidelines are needed subsequent to these policies in order to meet the dental population needs.

Original language	English (US)
Pages (from-to)	402-412
Number of pages	11
Journal	JDR Clinical and Translational Research
Volume	8
Issue number	4
DOIs	https://doi.org/10.1177/23800844221102830
State	Published - Oct 2023

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Research reported was supported by the Agency for Healthcare Research and Quality (AHRQ) under grant R01 HS25177 (PI: K.J. Suda). The sponsor had no role in the design or conduct of the study; data collection; management, analysis, and interpretation of the data; preparation; review or appraisal of the manuscript; and decision to submit the manuscript for publication. The content presented is the sole responsibility of the authors and does not necessarily represent the official views of the AHRQ, Department of Veterans Affairs, the US government, or IQVIA or any of its affiliated entities. The statements, findings, conclusions, views, and opinions contained and expressed in this study are based in part on data obtained under license from IQVIA: Longitudinal Prescription October 2012 to October 2016 (IQVIA, Inc.). The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Research reported was supported by the Agency for Healthcare Research and Quality (AHRQ) under grant R01 HS25177 (PI: K.J. Suda). The sponsor had no role in the design or conduct of the study; data collection; management, analysis, and interpretation of the data; preparation; review or appraisal of the manuscript; and decision to submit the manuscript for publication. The content presented is the sole responsibility of the authors and does not necessarily represent the official views of the AHRQ, Department of Veterans Affairs, the US government, or IQVIA or any of its affiliated entities. The statements, findings, conclusions, views, and opinions contained and expressed in this study are based in part on data obtained under license from IQVIA: Longitudinal Prescription October 2012 to October 2016 (IQVIA, Inc.). The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: C.H. Yan is an employee of AbbVie and may own stocks/shares in the company. C.C. Hubbard reports receiving support from grants from Pfizer outside the submitted work. G.S. Calip reports current employment with Flatiron Health, Inc., which is an independent subsidiary of the Roche group; stock ownership in Roche; and research funding from Pfizer awarded to the University of Illinois at Chicago. No other financial disclosures were reported by all other authors of this article.

Keywords

analgesic
dentist
dentistry
federal regulation
opioid
public policy

ASJC Scopus subject areas

General Dentistry

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10.1177/23800844221102830

Cite this

@article{b1330d79f29d4249b94f8a67d2a213b2,

title = "Impact of Hydrocodone Rescheduling on Dental Prescribing of Opioids",

abstract = "Introduction: In the United States, dentists frequently prescribe hydrocodone. In October 2014, the US Drug Enforcement Administration rescheduled hydrocodone from controlled substance schedule III to II, introducing more restricted prescribing and dispensing regulations, which may have changed dental prescribing of opioids. Objective: The study aim was to evaluate the impact of the hydrocodone rescheduling on dental prescribing of opioids in the United States. Methods: This was a cross-sectional study of opioids prescribed by dentists between October 2012 and October 2016, using the IQVIA Longitudinal Prescription Dataset. Monthly dentist-based opioid prescribing rate (opioid prescription [Rx]/1,000 dentists) and monthly average opioid dosages per prescription (mean morphine milligram equivalent per day [MME/d]) were measured in the 24 mo before and after hydrocodone rescheduling in October 2014 (index or interruption). An interrupted time-series analysis was conducted using segmented ordinary least square regression models, with Newey–West standard errors to handle autocorrelation. Results: Dentists prescribed 50,412,942 opioid prescriptions across the 49 mo. Hydrocodone was the most commonly prescribed opioid pre- and postindex (74.9% and 63.8%, respectively), followed by codeine (13.8% and 21.6%), oxycodone (8.1% and 9.5%), and tramadol (2.9% and 4.8%). At index, hydrocodone prescribing immediately decreased by −834.8 Rx/1,000 dentists (95% confidence interval [CI], −1,040.2 to −629.4), with increased prescribing of codeine (421.9; 95% CI, 369.7–474.0), oxycodone (85.3; 95% CI, 45.4–125.2), and tramadol (111.8; 95% CI, 101.4–122.3). The mean MME increased at index for all opioids except for hydrocodone, and dosages subsequently decreased during the postindex period. Conclusion: Following the rescheduling, dentist prescribing of hydrocodone declined while prescribing of nonhydrocodone opioids increased. Understanding the impact of this regulation informs strategies to ensure appropriate prescribing of opioids for dental pain. Knowledge Transfer Statement: The study findings can be used by policy makers to make informed decisions in developing future risk mitigation strategies aimed to regulate opioid prescribing behaviors. Furthermore, dentist-specific resources and guidelines are needed subsequent to these policies in order to meet the dental population needs.",

keywords = "analgesic, dentist, dentistry, federal regulation, opioid, public policy",

author = "Yan, {C. H.} and Hubbard, {C. C.} and Lee, {T. A.} and Sharp, {L. K.} and Evans, {C. T.} and Calip, {G. S.} and Rowan, {S. A.} and McGregor, {J. C.} and Gellad, {W. F.} and Suda, {K. J.}",

note = "Publisher Copyright: {\textcopyright} International Association for Dental, Oral, and Craniofacial Research and American Association for Dental, Oral, and Craniofacial Research 2022.",

year = "2023",

month = oct,

doi = "10.1177/23800844221102830",

language = "English (US)",

volume = "8",

pages = "402--412",

journal = "JDR Clinical and Translational Research",

issn = "2380-0844",

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number = "4",

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TY - JOUR

T1 - Impact of Hydrocodone Rescheduling on Dental Prescribing of Opioids

AU - Yan, C. H.

AU - Hubbard, C. C.

AU - Lee, T. A.

AU - Sharp, L. K.

AU - Evans, C. T.

AU - Calip, G. S.

AU - Rowan, S. A.

AU - McGregor, J. C.

AU - Gellad, W. F.

AU - Suda, K. J.

N1 - Publisher Copyright: © International Association for Dental, Oral, and Craniofacial Research and American Association for Dental, Oral, and Craniofacial Research 2022.

PY - 2023/10

Y1 - 2023/10

N2 - Introduction: In the United States, dentists frequently prescribe hydrocodone. In October 2014, the US Drug Enforcement Administration rescheduled hydrocodone from controlled substance schedule III to II, introducing more restricted prescribing and dispensing regulations, which may have changed dental prescribing of opioids. Objective: The study aim was to evaluate the impact of the hydrocodone rescheduling on dental prescribing of opioids in the United States. Methods: This was a cross-sectional study of opioids prescribed by dentists between October 2012 and October 2016, using the IQVIA Longitudinal Prescription Dataset. Monthly dentist-based opioid prescribing rate (opioid prescription [Rx]/1,000 dentists) and monthly average opioid dosages per prescription (mean morphine milligram equivalent per day [MME/d]) were measured in the 24 mo before and after hydrocodone rescheduling in October 2014 (index or interruption). An interrupted time-series analysis was conducted using segmented ordinary least square regression models, with Newey–West standard errors to handle autocorrelation. Results: Dentists prescribed 50,412,942 opioid prescriptions across the 49 mo. Hydrocodone was the most commonly prescribed opioid pre- and postindex (74.9% and 63.8%, respectively), followed by codeine (13.8% and 21.6%), oxycodone (8.1% and 9.5%), and tramadol (2.9% and 4.8%). At index, hydrocodone prescribing immediately decreased by −834.8 Rx/1,000 dentists (95% confidence interval [CI], −1,040.2 to −629.4), with increased prescribing of codeine (421.9; 95% CI, 369.7–474.0), oxycodone (85.3; 95% CI, 45.4–125.2), and tramadol (111.8; 95% CI, 101.4–122.3). The mean MME increased at index for all opioids except for hydrocodone, and dosages subsequently decreased during the postindex period. Conclusion: Following the rescheduling, dentist prescribing of hydrocodone declined while prescribing of nonhydrocodone opioids increased. Understanding the impact of this regulation informs strategies to ensure appropriate prescribing of opioids for dental pain. Knowledge Transfer Statement: The study findings can be used by policy makers to make informed decisions in developing future risk mitigation strategies aimed to regulate opioid prescribing behaviors. Furthermore, dentist-specific resources and guidelines are needed subsequent to these policies in order to meet the dental population needs.

AB - Introduction: In the United States, dentists frequently prescribe hydrocodone. In October 2014, the US Drug Enforcement Administration rescheduled hydrocodone from controlled substance schedule III to II, introducing more restricted prescribing and dispensing regulations, which may have changed dental prescribing of opioids. Objective: The study aim was to evaluate the impact of the hydrocodone rescheduling on dental prescribing of opioids in the United States. Methods: This was a cross-sectional study of opioids prescribed by dentists between October 2012 and October 2016, using the IQVIA Longitudinal Prescription Dataset. Monthly dentist-based opioid prescribing rate (opioid prescription [Rx]/1,000 dentists) and monthly average opioid dosages per prescription (mean morphine milligram equivalent per day [MME/d]) were measured in the 24 mo before and after hydrocodone rescheduling in October 2014 (index or interruption). An interrupted time-series analysis was conducted using segmented ordinary least square regression models, with Newey–West standard errors to handle autocorrelation. Results: Dentists prescribed 50,412,942 opioid prescriptions across the 49 mo. Hydrocodone was the most commonly prescribed opioid pre- and postindex (74.9% and 63.8%, respectively), followed by codeine (13.8% and 21.6%), oxycodone (8.1% and 9.5%), and tramadol (2.9% and 4.8%). At index, hydrocodone prescribing immediately decreased by −834.8 Rx/1,000 dentists (95% confidence interval [CI], −1,040.2 to −629.4), with increased prescribing of codeine (421.9; 95% CI, 369.7–474.0), oxycodone (85.3; 95% CI, 45.4–125.2), and tramadol (111.8; 95% CI, 101.4–122.3). The mean MME increased at index for all opioids except for hydrocodone, and dosages subsequently decreased during the postindex period. Conclusion: Following the rescheduling, dentist prescribing of hydrocodone declined while prescribing of nonhydrocodone opioids increased. Understanding the impact of this regulation informs strategies to ensure appropriate prescribing of opioids for dental pain. Knowledge Transfer Statement: The study findings can be used by policy makers to make informed decisions in developing future risk mitigation strategies aimed to regulate opioid prescribing behaviors. Furthermore, dentist-specific resources and guidelines are needed subsequent to these policies in order to meet the dental population needs.

KW - analgesic

KW - dentist

KW - dentistry

KW - federal regulation

KW - opioid

KW - public policy

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Impact of Hydrocodone Rescheduling on Dental Prescribing of Opioids

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