Comparison of Opioid Prescribing by Dentists in the United States and England
Comparison of Opioid Prescribing by Dentists in the United States and England
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DOI：
10.1001/jamanetworkopen.2019.4303
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发表时间：
2019-05-01
影响因子：
13.8
通讯作者：
Thornhill, Martin H.
中科院分区：
文献类型：
--
作者：
Suda, Katie J.;Durkin, Michael J.;Thornhill, Martin H.
美国消费了世界上大部分的阿片类药物，尽管它只占世界人口的一小部分。牙医是美国最常见的阿片类药物处方者之一，尽管数据表明非阿片类镇痛药对口腔疼痛同样有效。虽然美国和英国的口腔健康和牙医使用情况大致相似，但目前尚不清楚牙医开阿片类药物的情况在这两个国家之间有何不同。2016年，美国和英国的牙医。数据分析时间为2018年10月至2019年1月。暴露牙医开具的阿片类药物。主要结局和指标阿片类药物处方的比例和处方率。结果2016年，美国牙医开具的阿片类药物处方比例是英国牙医开具的比例的37倍。总的来说，22.3%的美国牙科处方是阿片类药物（1140万张处方），而英国牙科处方为0.6%（28082张处方）（差异，21.7%; 95%CI，13.8%-32.1%; P <0.001）。美国的牙医每1000人的阿片类药物处方数量也较高（35.4/1000美国人口[95% CI，25.2-48.7/1000人口] vs 0.5/1000英格兰人口[95% CI，0.03-3.7/1000人]）和每名牙医的阿片类处方数量（每位牙医58.2张处方[95% CI，每位牙医44.9-75.0张处方] vs每位牙医1.2张处方[95% CI，每位牙医0.2-5.6张处方]）。虽然可待因衍生物双氢可待因是英国牙医处方的唯一阿片类药物，但美国牙医处方的阿片类药物范围包括氢可酮（62.3%）、可待因（23.2%）、羟考酮（9.1%）和曲马多（4.8%）。美国的牙医也开了长效阿片类药物（占美国牙医开的阿片类药物的0.06%[6425张处方]）。结论和相关性这项研究发现，在2016年，美国的牙医开阿片类药物的频率明显高于他们的英国同行。滥用可能性很高的阿片类药物，如羟考酮，经常由美国牙医处方，但在英国没有处方。这些结果说明了阿片类药物的来源在美国与英国之间的差异。为了减少美国的牙科阿片类药物处方，牙医可以采取类似于英国使用的措施，包括强调保守处方阿片类药物的国家牙痛治疗指南。
IMPORTANCE The United States consumes most of the opioids worldwide despite representing a small portion of the world's population. Dentists are one of the most frequent US prescribers of opioids despite data suggesting that nonopioid analgesics are similarly effective for oral pain. While oral health and dentist use are generally similar between the United States and England, it is unclear how opioid prescribing by dentists varies between the 2 countries.OBJECTIVE To compare opioid prescribing by dentists in the United States and England.DESIGN, SETTING, AND PARTICIPANTS Cross-sectional study of prescriptions for opioids dispensed from outpatient pharmacies and health care settings between January 1 and December 31, 2016, by dentists in the United States and England. Data were analyzed from October 2018 to January 2019.EXPOSURES Opioids prescribed by dentists.MAIN OUTCOMES AND MEASURES Proportion and prescribing rates of opioid prescriptions.RESULTS In 2016, the proportion of prescriptions written by US dentists that were for opioids was 37 times greater than the proportion written by English dentists. In all, 22.3% of US dental prescriptions were opioids (11.4 million prescriptions) compared with 0.6% of English dental prescriptions (28 082 prescriptions) (difference, 21.7%; 95% CI, 13.8%-32.1%; P < .001). Dentists in the United States also had a higher number of opioid prescriptions per 1000 population (35.4 per 1000 US population [95% CI, 25.2-48.7 per 1000 population] vs 0.5 per 1000 England population [95% CI, 0.03-3.7 per 1000 population]) and number of opioid prescriptions per dentist (58.2 prescriptions per dentist [95% CI, 44.9-75.0 prescriptions per dentist] vs 1.2 prescriptions per dentist [95% CI, 0.2-5.6 prescriptions per dentist]). While the codeine derivative dihydrocodeine was the sole opioid prescribed by English dentists, US dentists prescribed a range of opioids containing hydrocodone (62.3%), codeine (23.2%), oxycodone (9.1%), and tramadol (4.8%). Dentists in the United States also prescribed long-acting opioids (0.06% of opioids prescribed by US dentists [6425 prescriptions]). Long-acting opioids were not prescribed by English dentists.CONCLUSIONS AND RELEVANCE This study found that in 2016, dentists in the United States prescribed opioids with significantly greater frequency than their English counterparts. Opioids with a high potential for abuse, such as oxycodone, were frequently prescribed by US dentists but not prescribed in England. These results illustrate how 1 source of opioids differs substantially in the United States vs England. To reduce dental opioid prescribing in the United States, dentists could adopt measures similar to those used in England, including national guidelines for treating dental pain that emphasize prescribing opioids conservatively.