Are dentists being targeted for codeine?

empty dental consult room

A dentist and pharmacist has identified an increase in the prescribing by dentists of opioids, and suggests they should have access to real-time monitoring systems

In a new article in Australian Prescriber, dentist and pharmacist Dr Leanne Teoh from the University of Melbourne examines an increase in opioid prescribing in dentistry, including following the upschedule of low-dose codeine products which were formerly available over the counter in pharmacies.

“Codeine is no longer recommended by the Therapeutic Guidelines,” Dr Teoh writes. “It was rescheduled to a prescription-only medicine in February 2018.

“Since then, codeine misuse and sales appear to have reduced overall. However, there was an increase in dental prescriptions of codeine 30mg (with paracetamol 500mg) and oxycodone by 21% and 24% respectively one year after the rescheduling in comparison to the previous year.

“There is evidence that people can become dependent on opioids as a result of codeine initiated for dental pain. In the United States a pre-filled opioid prescription, given for the extraction of wisdom teeth, has been found to be an independent risk factor for persistent opioid use.

“Dentists may also be targets of ‘doctor shopping’, in which drug-dependent people seek drugs for misuse from multiple prescribers.

“Including dentists in real- time prescription monitoring programs would allow them to make more informed prescribing decisions.

“These monitoring systems can currently only be accessed by pharmacists, doctors and nurses.”

Dr Teoh writes that as the most common source of drugs for misuse is leftover product from legitimate scripts, it is a concern that dentists can prescribe standard PBS pack sizes, when patients may need fewer pills.

In August the AJP reported on research by University of Western Australia PhD scholar Dr Alex Park, who noted an increase in prescribing by dentists of drugs of concern including opioids and benzodiazepines.

“Since January 2020, codeine was no longer recommended for analgesia in dentistry,” Dr Park said at the time. “This was in accordance with the Therapeutic Guidelines set out in Australia.

“Paracetamol/codeine appears to be consistently highly used. This raises the question of whether dentists are aware of the necessary changes or whether if they are not adhering to the guidelines provided.”

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