1 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
Background 2 • 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.
Methods 3 • 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. 210,993 896,378 28,151,790 (25.4%) • Individuals receiving any opioid analgesics within 14 days of the primary (3.2%) had Medicaid Prescribed opioid primary dental beneficiaries prescription dental diagnosis were identified. diagnosis from 13 states in within 14 days of 1/1/2013- Truven database their dental • Dental diagnosis was classified into 4 categories & Health Care Providers 9/30/2015 -2013-15 diagnosis (HCPs) were classified as Emergency Department (ED-HCPs), Dentists, Physicians, Nurse Practitioners (NPs), and Other HCPs. Results • 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 Emergency Department Vs Dentist Medical Specialist Vs Dentist (65.8%), non-Hispanic whites (57.8%), and those receiving care from ED HCPs Nurse Practitioner Vs Dentist (36.8%) Other Sources Vs Dentist Female Vs Male • ED-HCPs are 4 times more likely and NPs are more than 2 times more likely to White Vs Hispanic prescribe an opioid for a dental diagnosis compared to a dentist . African-American VS Hispanic Others Vs Hispanic • 10% patients received an opioid following a dental diagnosis by a dentist Odds Ratio compared to 47% patients receving opioid by ED-HCPs for dental diagnosis 1 1.9 2.8 3.7 4.6 Figure: Multivariable regression results receipt opioids following a dental diagnosis
Conclusions 4 • 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.
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