Empowering Dentists to Reduce Opioid Prescriptions to Young People

ABSTRACT Dentists are a leading prescriber of opioids to adolescents and young adults (AYAs), even though opioid use after tooth extraction is not associated with improved pain control. In AYAs, an opioid prescription after a dental procedure also increases the risk of long-term use and abuse. The long-term goal of this project is to develop a framework to reduce opioid prescriptions to AYAs after tooth extraction. The objective of this proposal is to establish the effectiveness of a multicomponent intervention at reducing dental opioid prescription rates. 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 can address provider beliefs, knowledge, choice architecture, and motivations more than one component of a prescriber’s decision-making process. We will test this hypothesis by pursuing four specific aims: in the UG3 phase, 1) complete requisite preliminary work to test a new approach to manage acute pain following dental treatment, and in the UH3 phase: 1) establish effectiveness of a novel approach using academic detailing, patient education, and blister-packaged non-opioid analgesics to reduce opioid prescriptions following tooth extraction among AYAs; 2) align implementation outcomes with dental professional decision-making behavior; 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 oral surgery clinics across Kentucky using a multicomponent intervention consisting of academic detailing, patient education, and standardized blister packs containing acetaminophen and ibuprofen. This innovative combination will assess effectiveness using a primary endpoint of a patient-level binary indicator of being prescribed an opioid. Secondary endpoints include intervention acceptability, appropriateness, and feasibility; intervention fidelity; and patient-reported pain, interference, analgesic use, and drug disposal. 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, reducing opioid prescription rates after tooth extraction. The expected outcome is an improved understanding of the effectiveness of interventions to reduce dental opioid prescribing, specifically to a high-risk cohort of patients. 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.