As part of its work to address the opioid epidemic, UnitedHealthcare is turning its attention to the role dental care plays in the crisis.
It's no small thing.
Dentists prescribe 12% of opioids nationwide. But they prescribe 54% of the opioids that end up getting dispensed to people aged 19 and under, according to data from the insurer. A 2018 study found that 80% of those aged 13 to 30 eventually fill an opioid prescription after a wisdom tooth removal procedure.
For many adolescents, a routine wisdom tooth extraction is their first exposure to opioids. This age group is especially vulnerable to addiction, Michael Mermigas, clinical director of national dental opioid policy at UnitedHealthcare, told FierceHealthcare.
“Dentistry has an impact on this age band as far as an introduction to opioids,” he said.
The 2018 study, published in the Journal of the American Medical Association, found that those who filled an opioid prescription after a wisdom tooth removal were nearly three times as likely to continue taking opioids over the following year.
UHC has launched several initiatives to mitigate these issues.
In 2018, the insurer launched a new pharmacy policy aimed at curbing first-time opioid prescriptions for teenagers that exceed three days and 50 morphine milligram equivalents per day, guidelines suggested by the Centers for Disease Control and Prevention.
Under that policy, it saw an 89% decrease in such prescriptions. Mermigas said that any prescription for someone 19 or younger that exceeds these guidelines is immediately flagged for UnitedHealthcare to follow up with the dentist.
“There’s outreach to the provider to further explore the clinical basis for that prescription,” he said.
UnitedHealthcare also tracked which dentists were consistently prescribing opioids outside of the guidelines and conducted further education on the risks with them. The insurer reached out to 2,800 dental providers last year, and prescriptions improved by 12% as a result, officials said.
Most recently, the insurer released a toolkit that aims to better inform both providers and patients about the potential risks of taking opioid painkillers.
The toolkit includes a handout for patients with questions they should ask their dentist before surgery, such as how to seek potential opioid alternatives to manage any pain and how to take opioids safely.
It also encourages patients to ask about the side effects of opioids interacting with other medications they take and about addiction risk. The toolkit also offers a checklist for setting goals for postoperative pain management to assist in sticking with a plan that avoids or minimizes opioid use.
The insurer also reaches out via email to members who undergo a wisdom tooth extraction within information about the risks in taking opioids. About 72,000 members aged 16 to 22 have received this outreach to date.