Initial opioid prescribing practices among providers treating an opioid-naïve US military sample.

Introduction: General opioid prescribing has decreased in response to practice guidelines and policy changes, but information on recent practices in initial opioid prescribing is needed to support interventions to reduce the risk of long-term opioid prescription use.

Methods: This cross-sectional study examined Military Health System data between 1 October 2015 and 30 September 2021 to explore initial opioid prescriptions and prescribing practices among providers serving 1.66 million US service members. We compared the characteristics of a subgroup (n=372 960) receiving an initial opioid within 7-24 months after study entry with those of the sample as a whole. We described characteristics of initial opioid prescriptions, including healthcare encounters associated with those prescriptions, prescriber characteristics and opioid prescribing practices.

Results: The analytic sample was composed of 1 666 019 service members, 372 960 of whom filled an initial opioid prescription 7-24 months after study entry. The analytic sample was 83% assigned male; 58% white, non-Hispanic, 16% black, non-Hispanic and 15% Hispanic; and had a mean age of 27 (8.02). Initial opioid fills had a median days' supply of four (IQR 3.0-5.0) and milligram morphine equivalents (MME) of 30 (IQR 20-50). 10% of prescribers wrote the majority (64%) of initial opioid fills, representing 67% of total initial opioid MME. Dental encounters were associated with 38% of initial opioid fills, and 19% of fills were associated with musculoskeletal conditions. Dentists were associated with 32% of total initial opioid fills and 25% of total initial opioid MME.

Conclusions: During recent years in the Military Health System, dental care was an important driver of initial opioid receipt among a relatively young population with full dental coverage. Similar populations may benefit from interventions that support dental providers in maintaining within-guideline prescribing practices.