Empowering dentists to reduce opioid prescriptions to young people

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ABSTRACT Dentists are the leading prescriber of opioids to adolescents and young adults (AYAs), even though opioid use after tooth extraction is not associated with improved pain control or satisfaction. In AYAs, an opioid prescription after a dental procedure increases the risk of opioid misuse, use disorder, and overdose. The long-term goal of this project is to develop a framework to reduce opioid prescriptions to AYAs for treatment of acute dental pain. The objective of this proposal is to establish the effectiveness of a multicomponent intervention at reducing dental opioid prescription rates after tooth extraction in AYAs. Our central hypothesis is that a multicomponent intervention is required to produce significant reductions in post-extraction opioid prescriptions to AYAs. The rationale underlying this proposal is that a multicomponent intervention will address provider knowledge, motivation, and choice architecture better than a single-component strategy; will engage and educate patients; and will provide a physical item for distribution instead of an opioid prescription. We will test this hypothesis by pursuing four specific aims: in the UG3 period, 1) complete requisite preliminary work to test a new approach to manage acute pain following dental treatment, and in the UH3 period: 1) establish effectiveness of a novel educational and drug-dispensing approach using academic detailing, patient education, and blister-packaged non-opioid analgesics to reduce opioid prescriptions following tooth extraction among AYAs; 2) examine key implementation outcomes of the intervention designed to modify dental professional decision-making behaviors; and 3) assess patient-reported pain management, analgesic use, and drug disposal after tooth extraction. To accomplish these aims, we propose a stepped wedge cluster randomized trial of community and academic clinics across Kentucky using an innovative intervention of one-on-one provider education plus provider distribution of patient education materials and standardized blister packs containing acetaminophen and ibuprofen. This study will be conducted across at least 10 of the largest oral surgery practices in Kentucky, enrolling at least 27 providers expected to perform tooth extractions on over 40,000 AYAs. We will assess effectiveness using a primary endpoint of the patient-level binary indicator of being prescribed an opioid. Secondary endpoints include intervention acceptability, appropriateness, feasibility, and fidelity (UH3 aim 2); and patient-reported pain, pain interference, analgesic use, and drug disposal (UH3 aim 3). The proposed research is significant because it will provide a framework for wide-scale implementation of interventions to modify dental decision-making behaviors towards evidence-based recommendations for acute pain management, resulting in a reduction in opioid prescription rates after tooth extraction. The expected outcome is a framework to implement effective interventions to reduce dental opioid prescribing to AYAs. The results will have a positive impact immediately because they will limit unnecessary opioid exposure, and long-term because they will help dentistry build a framework for reducing the impact of substance use disorders across the United States.