Abstract
Background
Dentists in the United States frequently prescribe opioids for dental-related pain,
although evidence shows superior efficacy of nonopioids for pain management. A national
sample of US dentists was interviewed to understand the barriers and facilitators
to opioid prescribing.
Methods
Semistructured one-on-one telephone interviews were conducted with dentists sampled
from the 6 regions of The National Dental Practice-Based Research Network. Responses
were coded into the domains of the Capability, Opportunity and Motivation Model of
Behavior. Potential behavior change interventions were identified for targeted themes.
Results
Seventy-three interviews were qualitatively analyzed. Most of those interviewed were
general dentists (86.3%) and on average (SD) were in practice for 24.3 (13.0) years.
Ten themes were identified within the Capability, Opportunity and Motivation Model
of Behavior. Dentists’ knowledge of opioid risk, ability to identify substance use
disorder behavior, and capability of communicating pain management plans to patients
or following clinic policies or state and federal regulations were linked with judicious
opioid prescribing. Dentists reported prescribing opioids if they determined clinical
necessity or feared negative consequences for refusing to prescribe opioids.
Conclusions
Dentists’ opioid decision making is influenced by a range of real-world practice experiences
and patient and clinic factors. Education and training that target dentists’ knowledge
gaps and changes in dentists’ practice environment can encourage effective communication
of pain management strategies with patients and prescribing of nonopioids as first-line
analgesics while conserving opioid use.
Practical Implications
Identified knowledge gaps in dentistry can be targets for education, clinical guidelines,
and policy interventions to ensure safe and appropriate prescribing of opioids.
Article Info
Publication History
Published online: July 18, 2022
Publication stage
In Press Corrected Proof
Footnotes
The National Dental Practice-Based Research Network Collaborative Group comprises practitioners, faculty, and staff investigators who contributed to this network activity. A list of these contributors can be found at http://www.nationaldentalpbrn.org/collaborative-group.php.
Disclosures. Dr. Yan reported employment with AbbVie at the time of submission. Dr. Suda reported grants from US Veterans Health Administration, National Institute of Drug Abuse, Centers for Disease Control and Prevention , US Food and Drug Administration , and Agency for Healthcare Research and Quality outside the submitted work. Dr. Evans reported grants from US Veterans Health Administration and National Institutes of Health and ownership in Canna Ventures and CESAM . Dr. Calip reported current employment with Flatiron Health, which is an independent subsidiary of the Roche group; stock ownership in Roche; and research funding from Pfizer awarded to the University of Illinois at Chicago . None of the other authors reported any disclosures.
ORCID Numbers. Connie H. Yan: https://orcid.org/0000-0003-1467-4666; Swetha Ramanathan: https://orcid.org/0000-0001-8620-6584; Tumader Khouja: https://orcid.org/0000-0001-6042-4866; Charlesnika T. Evans: https://orcid.org/0000-0002-0696-8288; Todd A. Lee: https://orcid.org/0000-0003-3619-5367; Gregory S. Calip: https://orcid.org/0000-0002-7744-3518; Walid F. Gellad: https://orcid.org/0000-0002-6992-5197; Lisa K. Sharp: https://orcid.org/0000-0002-7809-9042. For information regarding ORCID numbers, go to http://orcid.org.
Opinions and assertions contained in this article are those of the authors and are not to be construed as necessarily representing the views of the respective organizations, the Agency for Healthcare Research and Quality, the National Institutes of Health, the Department of Veterans Affairs, the US government, or IQVIA or any of its affiliated entities. The statements, findings, conclusions, views, and opinions contained and expressed in this study are based in part on data obtained under license from IQVIA: Longitudinal Prescription January 2017 to December 2017, IQVIA.
Research reported in this article was supported by grant R01 HS25177 from the Agency for Healthcare Research and Quality and grants U19-DE-28717 and U19-DE-22516 from the National Institutes of Health . The sponsor had no role in the design or conduct of the study, data collection, management, analysis, and interpretation of the data, preparation, review or appraisal of the manuscript and decision to submit the manuscript for publication.
The authors gratefully acknowledge The National Dental Practice-Based Research Network (the “network”) regional coordinators and their contributions in the recruitment process of dentists into the study. Details about The National Dental Practice-Based Research Network are available at: http://NationalDentalPBRN.org. The authors also acknowledge members of the opioid advisory committee for their participation in discussions during the development of the interview guide and the dentists who partook in the pilot testing of the interview guide.
Identification
DOI: https://doi.org/10.1016/j.adaj.2022.05.009
Copyright
© 2022 American Dental Association. All rights reserved.
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