Potentially Inappropriate Medication Combination with Opioids among Older Dental Patients: A Retrospective Review of Insurance Claims Data.

INTRODUCTION: Opioid prescribing by dentists for older patients receiving medications with potential contraindications and the subsequent impact on acute care outcomes is not well described.

OBJECTIVES: Our objective was to evaluate the use of potentially inappropriate medication combinations (PIMC) involving opioids prescribed by dentists according to the Beers criteria and risks of 30-day emergency room (ER) visits and all-cause hospitalization among commercially insured dental patients ages 65 years and older.

METHODS: We conducted a retrospective cohort study of 40,800 older dental patient visits where opioids were prescribed between 2011 and 2015 using the Truven Health MarketScan® databases. Data collection from dental, medical, and pharmacy claims included information on the concurrent use of PIMCs and outcomes of all-cause acute care utilization over the 30-day period after dental encounters.

RESULTS: For the overall cohort, the median age was 69 years, and 45% were female. The prevalence of PIMCs per Beers Criteria was 10.4%. A total of 947 all-cause acute care events were observed in the 30 days post-dental visit. Patients with PIMCs involving opioids prescribed by dentists according to the Beers criteria had higher rates of acute care use (3.3% vs. 2.2%, p<0.001), which were associated with an increased risk of all-cause acute care utilization (adjusted RR 1.23; 95% CI 1.02-1.48). A dose-response relationship was seen with increasing oral morphine equivalents prescribed and increased acute care utilization (P<0.001).

CONCLUSION: A significant proportion of older patients receiving opioids at dental visits use psychotropic medications that in combination should be avoided according to the American Geriatric Society Beers criteria.