Unused Wisdom Teeth Prescriptions Fuel Opioid Diversion

More than 100 million prescriptions annually go unused after dental surgical procedures, contributing to the ongoing opioid abuse epidemic, according to a new study.

Researchers at the University of Pennsylvania (Penn; Philadelphia, USA) conducted a randomized controlled trial of opioid prescribing and consumption patterns among patients undergoing surgical tooth extraction. The primary outcome was the number of unused opioid pills remaining on postoperative day 21, with the secondary outcome being measurement of the effect of a behavioral intervention (informing patients of a pharmacy-based opioid disposal program) on the proportion of patients who disposed or reported intent to dispose of unused opioids.

For the study, the researchers enrolled 79 patients, with the majority (94%) receiving a prescription for an opioid to manage pain, 82% receiving an additional prescription for a nonsteroidal anti-inflammatory drug (NSAID), and 78% receiving a prescription antibiotic. Just 24 hours after surgery, patients reported an average pain score of 5 out of 10 while taking pain medication. By the second day, more than half reported a low pain score, and by the fifth day, almost 80% had a low pain score.

On average, participants who did not have post-surgical complications received prescriptions containing 28 opioid pills, but three weeks following surgery had only used 13, leaving more than 1,000 unused opioid pills. Only five patients used all of the prescribed pills. The behavioral intervention was associated with a 22% absolute increase in the proportion of patients who disposed or reported intent to dispose of unused opioids. The study was published on August 16, 2016, in Drug and Alcohol Dependence.

“When translated to the broad U.S. population, our findings suggest that more than 100 million opioid pills prescribed to patients following surgical removal of impacted wisdom teeth are not used, leaving the door open for possible abuse or misuse by patients, or their friends or family,” said lead author Brandon Maughan, MD, MHS, MSHP. “Given the increasing concern about prescription opioid abuse in the United States, all prescribers, including physicians, oral surgeons and dental clinicians, have a responsibility to limit opioid exposure, to explain the risks of opioid misuse, and educate patients on proper drug disposal.”

“Results of our study show within five days of surgery, most patients are experiencing relatively little pain, and yet, most still had well over half of their opioid prescription left,” said study co-author Professor Elliot Hersh, DMD, PhD, of the department of oral & maxillofacial surgery and pharmacology. “Prescription-strength NSAIDs, like ibuprofen, combined with acetaminophen, can offer more effective pain relief and fewer adverse effects than opioid-containing medications. While opioids can play a role in acute pain management after surgery, they should only be added in limited quantities for more severe pain.”

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