Trends in Opioid Prescriptions to Opioid-Naïve Patients by Oral and Maxillofacial Surgeons in Massachusetts 2012-2022.

Abstract

Background: Many oral and maxillofacial surgery patients are young, healthy adults who are opioid-naïve. Over-prescribing opioids increases the risk of subsequent misuse and diversion.

Purpose: The purpose of this study was to measure and compare opioid prescriptions to opioid naïve and nonnaïve patients by oral and maxillofacial surgeons in Massachusetts from 2012 to 2022.

Study design, setting, sample: This retrospective cohort study used the Massachusetts Prescription Monitoring Program database to identify Schedule II and III opioid prescriptions by providers with specialty of "oral and maxillofacial surgery" from 2012 to 2022.

Predictor/exposure/independent variable: The predictor variable is opioid exposure coded as opioid naïve (yes/no). Opioid-naïve status was defined as not having filled an opioid prescription in the prior 12 months.

Main outcome variable: The main outcome variable was the quantity of opioid prescribed by oral and maxillofacial surgeons measured using morphine milligram equivalent (MME) per prescription. The secondary outcome was days' supply prescribed.

Covariates: Covariates of the study included patient age and sex.

Analyses: Descriptive statistics and weighted linear regressions were used to analyze differences in MME per prescription and days's supply per prescription to opioid-naïve and nonnaive patients each year and throughout the study period. P < .05 was considered statistically significant.

Results: The data included a total of 866,539 prescriptions to 679,616 opioid-naïve patients and 186,923 nonnaïve patients from 2012 to 2022. Compared to nonnaïve patients, the opioid-naïve cohort had a slightly higher proportion of females (P ≤ .01 except for 2020) and were significantly younger (35.9 vs 47.6 yrs, P ≤ .01 for all years). For every study year, there was no statistically significant difference in mean MME per prescription or days' supply per prescription between opioid-naïve and nonnaïve patients (P > .05 in all years for both variables). MME per prescription (β = -7.22, 95% CI: -7.65, -6.80; R² = 0.79) and days' supply per prescription (β = -0.11, 95% CI: -0.11, -0.10; R² = 0.78) decreased at a similar rate throughout the study period for both opioid-naïve and nonnaïve patients.

Conclusions and relevance: Oral and maxillofacial surgeons in Massachusetts predominantly prescribed opioids to opioid-naïve patients. The quantity and duration of initial prescriptions to opioid-naïve and nonnaïve patients were similar, yet both steadily decreasing, throughout the study period. These trends are encouraging in the context of recent responsible opioid prescribing policy interventions in Massachusetts.