Gender and Racial Disparities in Opioid Prescriptions for Dental - - PowerPoint PPT Presentation

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Gender and Racial Disparities in Opioid Prescriptions for Dental Diagnosis Among Medicaid Populations

Chandrashekar Janakiram PhD

National Institute of Dental and Craniofacial Research- National Institutes of Health

2018

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Background

• About 115 Americans die every day from an opioid overdose.
• Opioid prescribing by dentists is estimated at 12% of the overall opioid prescription total
• Among all non-cancer specialties, dentists provide the second fewest opioid prescriptions, after

primary care providers, (e.g.internists, family medicine physicians, and general practitioners)

• About 1,500 annual deaths may be attributable to unused opioids originally prescribed by dentists.

Objectives

• To explore variations in opioid prescriptions for dental diagnoses by health care providers for

Medicaid-enrolled children and adults in the US.

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Methods

210,993 (25.4%)

Prescribed opioid prescription within 14 days of their dental diagnosis

896,378 (3.2%) had

primary dental diagnosis 1/1/2013- 9/30/2015

28,151,790

Medicaid beneficiaries from 13 states in Truven database

• 2013-15
• Data: Medical and pharmacy Medicaid claims data for calendar years 2013

through 2015 from the Truven Market Scan Database Multi-state Medicaid core data set.

• Individuals receiving any opioid analgesics within 14 days of the primary

dental diagnosis were identified.

• Dental diagnosis was classified into 4 categories & Health Care Providers

(HCPs) were classified as Emergency Department (ED-HCPs), Dentists, Physicians, Nurse Practitioners (NPs), and Other HCPs.

• Among patients receiving an opioid within 14 days of a dental diagnosis, the

larger proportions were 19- through 29-year-olds (30.3%), female patients (65.8%), non-Hispanic whites (57.8%), and those receiving care from ED HCPs (36.8%)

• ED-HCPs are 4 times more likely and NPs are more than 2 times more likely to

prescribe an opioid for a dental diagnosis compared to a dentist.

• 10% patients received an opioid following a dental diagnosis by a dentist

compared to 47% patients receving opioid by ED-HCPs for dental diagnosis

Results

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Emergency Department Vs Dentist Medical Specialist Vs Dentist Nurse Practitioner Vs Dentist Other Sources Vs Dentist Female Vs Male White Vs Hispanic African-American VS Hispanic Others Vs Hispanic

Odds Ratio

Figure: Multivariable regression results receipt opioids following a dental diagnosis

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Conclusions

• Female patients were 50% more likely to fill an opioid prescription for any dental diagnosis

than men

• Non-Hispanic whites and African Americans were 2 times more likely to receive an opioid

than were Hispanics

• Opioid use was 3 times higher among African-American women and non-Hispanic white

women as compared to Hispanic women

• ED HCPs are more likely to prescribe an opioid for a dental diagnosis compared to other

provider types

• Evaluation of professional continuing educational efforts focusing on pain management

using opioid pain medications should be considered.