Opioid Prescribing to Adolescents in Dental Settings

United States

NIDA Organizer(s): Aria Crump, Sc.D., Jeff Schulden, M.D.

Meeting Purpose and Intent:

The National Institute on Drug Abuse (NIDA) and the National Institute of Dental and Craniofacial Research (NIDCR) organized this roundtable meeting with a small group of invited expert researchers and clinicians to discuss the current state of knowledge on the prescribing of opioid analgesics to adolescents in dental settings. In the spirit of understanding patient and clinician perceptions and behaviors related to the prevention of opioid misuse and abuse among adolescents, the intent was to include topical presentations by participants, discussant remarks, and moderated group discussion. The goal of the meeting was to discuss a range of topics, including: current research on standard practices for dentists for prescribing opioid analgesics; dentists' perceptions of the risk and safety of opioid analgesics; current knowledge regarding opioid misuse and abuse among adolescents; and the potential for prevention practices to reduce opioid diversion. In addition, the meeting would foster an improved understanding of the factors that influence opioid prescribing patterns in dental settings and the potential need for developing a specific research agenda on these issues involving dentists, oral surgeons, and drug abuse researchers.

Brief Discussion of Meeting Outcome:

Participants reported on a range of topics which served as the foundation for rich discussions throughout the day. Topics included:

• Current data on opioid prescribing practices in the U.S.;
• Standard practices for dentists for prescribing opioid analgesics;
• Dentists' perceptions of the risk and safety of opioids;
• Current knowledge on opioid diversion among adolescents; and
• Research on potential practices to curb diversion of prescription opioids.

Participants discussed that opioid analgesics have become more widely available because more patients of all ages are receiving prescriptions for these drugs from a range of clinical settings. A substantial proportion of opioid analgesic prescriptions for adolescents come from dentists, but the potential link to growing rates of prescription opioid abuse among adolescents remains unclear. Throughout the discussions, it was recognized that many questions remain unanswered about the risks associated with adolescent opioid analgesic use and the potential role of dentists and other clinicians in prevention of prescription opioid misuse and abuse. Participants agreed that there is a need to balance appropriately treating pain among dental patients while reducing potential exposure to risk.

Discussions highlighted several areas in which future research efforts could focus, including:

• The need for improved understanding of opioid prescribing practices in dental settings;
• Data on the amount of opioid analgesia that dentists typically prescribe, the amount that patients actually need/use for adequate pain relief, and what patients do with unused medication;
• More detailed understanding of medication diversion practices among adolescents; and
• Research on possible educational or training approaches to integrate drug abuse prevention efforts into dental settings.

Participants agreed that there are a number of opportunities for collaboration between the fields of dental and drug abuse research which would advance this research agenda.

Brief Description of Resulting Publications:

A report of the meeting findings is under development.