Opioid-prescribing Practices in a Graduate Endodontic Clinic before and after Implementation of the Federal Schedule II Prescribing Mandate

Andrew M. Broadsword, Christine Sedgley, Richie Kohli, Al M. Best, Karan J. Replogle

Research output: Contribution to journalArticle

Abstract

Introduction: Opioid prescriptions have the potential for misuse. In October 2014, the federal schedule II prescribing mandate reclassified hydrocodone combination products from schedule III to schedule II drugs that required a written prescription. The aim of this study was to evaluate the opioid-prescribing practices in a graduate endodontic clinic (GEC) before and after the mandate. Methods: Electronic health records from all patients treated in the GEC from 2010 to 2018 were reviewed retrospectively for opioid prescribing, the date of prescription, and the Current Dental Terminology code. Where opioid prescribing was documented in the electronic health record, additional data were extracted about pulpal and periapical diagnosis, pain level, opioid type, and prescription details. Prescribing rates were calculated and analyzed by using chi-square, analysis of variance, logistic regression, and multivariable analysis. Significance was set at P <.05. Results: Overall, 4851 patients underwent 7841 procedures; 92.2% of patients were never prescribed opioids. The remaining 380 patients underwent 420 procedures, and 509 prescriptions were provided. Prescribing rates were 7.5% (228/3021) before versus 4.0% (192/4820) after the mandate (P <.001). Hydrocodone combinations were the most prescribed opioid (77%, 392/509). Tramadol prescribing increased after the mandate (P =.023). Multivariable analysis showed significantly higher prescribing for apicoectomy procedures (P <.001). Preoperative pulpal and periapical diagnosis and pain level were not significantly associated with opioid prescribing. Conclusions: An overall reduction in opioid-prescribing rates occurred coincidentally with the 2014 federal mandate. The lack of correlation between prescribing and pain level highlighted the need for evidence-based rather than habitual prescribing protocols in the GEC.

Original languageEnglish (US)
JournalJournal of endodontics
DOIs
StateAccepted/In press - Jan 1 2019

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Endodontics
Opioid Analgesics
Appointments and Schedules
Prescriptions
Hydrocodone
Electronic Health Records
Pain
Apicoectomy
Tramadol
Terminology
Analysis of Variance
Tooth
Logistic Models
Regression Analysis

Keywords

  • Endodontic pain
  • federal schedule II opioid-prescribing mandate
  • graduate endodontic clinic
  • hydrocodone combinations
  • opioids
  • prescribing practices

ASJC Scopus subject areas

  • Dentistry(all)

Cite this

@article{3f735d98bfd140ebbe616e7f7ec65b22,
title = "Opioid-prescribing Practices in a Graduate Endodontic Clinic before and after Implementation of the Federal Schedule II Prescribing Mandate",
abstract = "Introduction: Opioid prescriptions have the potential for misuse. In October 2014, the federal schedule II prescribing mandate reclassified hydrocodone combination products from schedule III to schedule II drugs that required a written prescription. The aim of this study was to evaluate the opioid-prescribing practices in a graduate endodontic clinic (GEC) before and after the mandate. Methods: Electronic health records from all patients treated in the GEC from 2010 to 2018 were reviewed retrospectively for opioid prescribing, the date of prescription, and the Current Dental Terminology code. Where opioid prescribing was documented in the electronic health record, additional data were extracted about pulpal and periapical diagnosis, pain level, opioid type, and prescription details. Prescribing rates were calculated and analyzed by using chi-square, analysis of variance, logistic regression, and multivariable analysis. Significance was set at P <.05. Results: Overall, 4851 patients underwent 7841 procedures; 92.2{\%} of patients were never prescribed opioids. The remaining 380 patients underwent 420 procedures, and 509 prescriptions were provided. Prescribing rates were 7.5{\%} (228/3021) before versus 4.0{\%} (192/4820) after the mandate (P <.001). Hydrocodone combinations were the most prescribed opioid (77{\%}, 392/509). Tramadol prescribing increased after the mandate (P =.023). Multivariable analysis showed significantly higher prescribing for apicoectomy procedures (P <.001). Preoperative pulpal and periapical diagnosis and pain level were not significantly associated with opioid prescribing. Conclusions: An overall reduction in opioid-prescribing rates occurred coincidentally with the 2014 federal mandate. The lack of correlation between prescribing and pain level highlighted the need for evidence-based rather than habitual prescribing protocols in the GEC.",
keywords = "Endodontic pain, federal schedule II opioid-prescribing mandate, graduate endodontic clinic, hydrocodone combinations, opioids, prescribing practices",
author = "Broadsword, {Andrew M.} and Christine Sedgley and Richie Kohli and Best, {Al M.} and Replogle, {Karan J.}",
year = "2019",
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journal = "Journal of Endodontics",
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T1 - Opioid-prescribing Practices in a Graduate Endodontic Clinic before and after Implementation of the Federal Schedule II Prescribing Mandate

AU - Broadsword, Andrew M.

AU - Sedgley, Christine

AU - Kohli, Richie

AU - Best, Al M.

AU - Replogle, Karan J.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Introduction: Opioid prescriptions have the potential for misuse. In October 2014, the federal schedule II prescribing mandate reclassified hydrocodone combination products from schedule III to schedule II drugs that required a written prescription. The aim of this study was to evaluate the opioid-prescribing practices in a graduate endodontic clinic (GEC) before and after the mandate. Methods: Electronic health records from all patients treated in the GEC from 2010 to 2018 were reviewed retrospectively for opioid prescribing, the date of prescription, and the Current Dental Terminology code. Where opioid prescribing was documented in the electronic health record, additional data were extracted about pulpal and periapical diagnosis, pain level, opioid type, and prescription details. Prescribing rates were calculated and analyzed by using chi-square, analysis of variance, logistic regression, and multivariable analysis. Significance was set at P <.05. Results: Overall, 4851 patients underwent 7841 procedures; 92.2% of patients were never prescribed opioids. The remaining 380 patients underwent 420 procedures, and 509 prescriptions were provided. Prescribing rates were 7.5% (228/3021) before versus 4.0% (192/4820) after the mandate (P <.001). Hydrocodone combinations were the most prescribed opioid (77%, 392/509). Tramadol prescribing increased after the mandate (P =.023). Multivariable analysis showed significantly higher prescribing for apicoectomy procedures (P <.001). Preoperative pulpal and periapical diagnosis and pain level were not significantly associated with opioid prescribing. Conclusions: An overall reduction in opioid-prescribing rates occurred coincidentally with the 2014 federal mandate. The lack of correlation between prescribing and pain level highlighted the need for evidence-based rather than habitual prescribing protocols in the GEC.

AB - Introduction: Opioid prescriptions have the potential for misuse. In October 2014, the federal schedule II prescribing mandate reclassified hydrocodone combination products from schedule III to schedule II drugs that required a written prescription. The aim of this study was to evaluate the opioid-prescribing practices in a graduate endodontic clinic (GEC) before and after the mandate. Methods: Electronic health records from all patients treated in the GEC from 2010 to 2018 were reviewed retrospectively for opioid prescribing, the date of prescription, and the Current Dental Terminology code. Where opioid prescribing was documented in the electronic health record, additional data were extracted about pulpal and periapical diagnosis, pain level, opioid type, and prescription details. Prescribing rates were calculated and analyzed by using chi-square, analysis of variance, logistic regression, and multivariable analysis. Significance was set at P <.05. Results: Overall, 4851 patients underwent 7841 procedures; 92.2% of patients were never prescribed opioids. The remaining 380 patients underwent 420 procedures, and 509 prescriptions were provided. Prescribing rates were 7.5% (228/3021) before versus 4.0% (192/4820) after the mandate (P <.001). Hydrocodone combinations were the most prescribed opioid (77%, 392/509). Tramadol prescribing increased after the mandate (P =.023). Multivariable analysis showed significantly higher prescribing for apicoectomy procedures (P <.001). Preoperative pulpal and periapical diagnosis and pain level were not significantly associated with opioid prescribing. Conclusions: An overall reduction in opioid-prescribing rates occurred coincidentally with the 2014 federal mandate. The lack of correlation between prescribing and pain level highlighted the need for evidence-based rather than habitual prescribing protocols in the GEC.

KW - Endodontic pain

KW - federal schedule II opioid-prescribing mandate

KW - graduate endodontic clinic

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KW - opioids

KW - prescribing practices

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