Abstract
Purpose: Opioids, benzodiazepines and sedatives can manage dental pain, fear and anxiety but have a narrow margin of safety in children. General dentists may inappropriately prescribe gabapentin and stimulants. National evidence on dispensing rates of these high-alert medicines by dentists to children is limited. Methods: We utilize join-point regression to identify changes in fills for opioids, sedatives, benzodiazepines, gabapentin, and stimulants to children <18 years from 2012 to 2019 in a national dataset comprising 92% of dispensed outpatient prescriptions by dentists. Results: From 2012 to 2019, 3.8 million children filled prescriptions for high-alert drugs from general dentists. National quarterly dispensing of high-alert drugs decreased 63.1%, from 10456.0 to 3858.8 days per million. Opioids accounted for 69.4% of high-alert prescriptions. From 2012 to 2019, fills for opioids, sedatives, benzodiazepines, and stimulants decreased by 65.2% (7651.8 to 2662.7), 43.4% (810.9 to 458.7), 43.6% (785.7 to 442.7) and 89.3% (825.6 to 88.6 days per million), respectively. Gabapentin increased 8.1% (121.8 to 131.7 days per million). A significant decrease in high-alert fills occurred in 2016, (−6.0% per quarter vs. -1.6% pre-2016, P-value<0.001), especially for opioids (−7.0% vs. -1.2%, P-value<0.001). Older teenagers (15–17 years) received 42.5% of high-alert prescriptions. Low-income counties in the South were overrepresented among top-prescribing areas in 2019. Conclusions: We found promising national decreases in fills for high-alert medicines to children by general dentists from 2012 to 2019. However, older teenagers and children in some counties continued to receive dental opioids at high rates. Future efforts should address non-evidence-based pain management in these groups.
Original language | English (US) |
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Pages (from-to) | 625-634 |
Number of pages | 10 |
Journal | Pharmacoepidemiology and Drug Safety |
Volume | 32 |
Issue number | 6 |
DOIs | |
State | Published - Jun 2023 |
Funding
This project was funded through AHRQ R01 HS025177: “Dental prescribing of antibiotics and opioids: high use in the absence of evidence” (PI: KJ Suda). The funder/sponsor did not participate in the work.
Keywords
- children
- dentists
- drug safety
- opioids
ASJC Scopus subject areas
- Pharmacology (medical)
- Epidemiology