Do Oral and Maxillofacial Surgeons Prescribe More Opioids After Third Molar Removal for Patients with Substance Use History?

PURPOSE: Oral and maxillofacial surgeons (OMSs) must manage postoperative pain control for patients who take illicit substances. The purpose of this study was to measure and compare the amount of opioid prescribing between patients with and without self-reported substance use history (SUH) by OMSs after third molar (M3) removal.

MATERIALS AND

METHODS

The investigators implemented a retrospective cohort study and enrolled a sample of subjects who had M3 removal between January 1, 2019 through December 31, 2019. The primary predictor variable was SUH coded as yes (SUH+) or no (SUH-). The primary and secondary outcome variables were prescribed morphine milligram equivalents (MMEs) and number of postoperative visits due to inadequate pain control (IPC), respectively. Other variables were age, gender, payor, provider, anesthesia, and procedure specific. Descriptive, bivariate, and multiple linear regression models were computed.

RESULTS

The sample included 1,112 subjects with a mean age of 25 ± 9 years; 61.2% were female. Of the 1,112 subjects, 198 (17.8%) reported a SUH. Mean MMEs were 70.9 ± 27.9 and 63.4 ± 28.8 in the SUH+ and SUH- groups, respectively (P ≤ .001). An adjusted linear regression model showed a non-significant association between SUH and MMEs prescribed (P = .50). The study showed a non-significant increase (P = .15) in the proportion of patients with IPC in the SUH- group (4.1%) versus the SUH+ group (2.0%).

CONCLUSIONS

The results suggest that 10% more opioids were prescribed for postoperative pain after M3 removal for patients with SUH, though after adjustment, the amount may not be clinically significant. Postoperative pain management after M3 removal in patients with SUH, on average, can be managed in a similar manner as for patients without SUH.