Opioid prescribing by dentists in Medicare Part D: national trends and geographic variation

Introduction: Dentists are an important source of opioid prescriptions in the United States, but recent national and state-level trends in dental opioid prescribing to Medicare Part D beneficiaries are poorly quantified. Methods: We analyzed the public CMS Medicare Part D Prescribers by Provider dataset for 2013-2021, restricted to prescribers of type Dentist in the 50 states and the District of Columbia. Outcomes were annual opioid claims, the opioid prescribing rate per 100 total claims, opioid claims per dentist, the proportion of dentists with at least one opioid claim, and long-acting opioid share. Suppressed counts (1-10) were imputed at the midpoint with bounds of 1 and 10. Trends used log-linear regression; state variation used the coefficient of variation and Spearman correlation. Results: The analysis included 1,149,905 dentist-year records and 81,539,159 total claims. Opioid claims declined from 1,431,237 to 1,162,416, and the opioid rate fell from 18.8 to 11.0 per 100 claims (−41.3%), an annual percent change of −6.8% (95% CI −7.92 to −5.61). Dentists with at least one opioid claim declined from 84.1% to 64.8%. In 2021 state rates ranged from 4.1 (Maine) to 22.9 (Mississippi) per 100 claims; the coefficient of variation rose from 27.8% to 41.7%, and state rankings were stable (Spearman rho 0.88). Conclusions: Opioid prescribing by dentists to Medicare Part D beneficiaries declined substantially from 2013 to 2021, but marked and persistent state-level variation remains.