Are Oral and Maxillofacial Surgeons Prescribing Fewer Opioids and More Non-Narcotic Analgesics for Postoperative Pain After Third Molar Removal?

Purpose: In response to the national opioid epidemic crisis, the purpose of this study was to measure changes in opioid and non-narcotic analgesia (NNA) prescribing practices over time after third molar (M3) removal.

Materials and methods: A retrospective double cohort study was utilized enrolling 2 samples of patients who had M3s removed during 2 different 3-month intervals. The primary predictor variable was prescribing practice, divided into cohorts: 1) previous prescribing practice (PPP) occurring early during the evolving opioid epidemic (2014); and 2) current prescribing practice (CPP) (2018). The outcome measures were morphine milligram equivalents (MMEs), NNA prescriptions, and refill MMEs for inadequate pain control (IPC). Other variables were age, gender, payor, provider, anesthesia, procedure, and number of M3s removed. Descriptive, bivariate, and multiple linear and logistic regression models were computed.

Results: The sample included 330 subjects with a mean age of 23.1 ± 8.1 years; 42.4% were male. Of the 330 subjects, 147 were in the PPP cohort (44.5%) and 183 in CPP cohort (55.5%). Mean MMEs were 130.1 ± 42.4 and 68.5 ± 32.0 in the PPP and CPP cohorts, respectively (P ≤ .001). An adjusted linear regression model showed differences in MMEs prescribed persisted (P ≤ .001). The frequency of postoperative NNA prescriptions written increased from 2.7 to 71.6% (P ≤ .001). An adjusted logistic regression model also revealed that NNA prescriptions had significantly increased (odds ratio, 242.00; P ≤ .001). No difference was found in the frequency of refills for IPC (P = .13) or mean refill MME prescriptions between the cohorts (P = .48).

Conclusions: Within our academic practice, fewer opioids and more NNAs are being prescribed for postoperative pain after M3 removal without an increase in IPC. Increased awareness through prescribing regulations, non-narcotic research findings, and organizational guidelines could have contributed to these changes.