Why benefit plans should limit opioid use for common surgeries

Register now

A routine dental procedure can lead minors to a lifetime of addiction to painkillers — but not if their parents’ benefit plans are vigilant about monitoring opioid prescriptions.

Benefit provider UnitedHealthcare decided to rethink their prescription painkiller policies after reading studies by Stanford University and the Centers for Disease Control that say teenagers are at-risk of becoming addicted to opioids after having wisdom tooth surgery. The CDC says 70% of minors undergoing the procedure receive an opioid prescription; Stanford’s research says 6% of those teens become addicted.

“[Wisdom tooth surgery] is often teens’ first exposure to opioids, and there is a possibility addiction will manifest from this first encounter,” says Dr. Michael Mermigas, clinical director of national dental opioid policy for UnitedHealthcare. “But we can hold the industry accountable to combat the opioid epidemic.”

In response, UnitedHealthcare capped first-time opioid prescriptions to three days and under 50 milligrams. The company also reaches out to dentists who are prescribing more opioids than the CDC guidelines to educate them on best practices. Since enacting the policies three years ago, UnitedHealthcare has seen an 89% reduction in opioid prescriptions for patients 19-years-old and under.

Mermigas spoke in a recent interview about why employers should do their part to prevent opioid addiction in teenagers.

Why should employers get involved in preventing opioid addiction in teenagers?

The opioid crisis claims 130 people every day, and we’re learning that addiction can start from a young age because wisdom teeth extractions are a pretty common occurrence in our society. It’s better to get ahead and have a plan in place to prevent addiction in this vulnerable age group.

Addiction doesn’t only affect the patient, it hurts the whole family and, by extension, the whole workplace. Familial issues like this could definitely impact an employee’s ability to perform their job. And getting the minor the help they need to overcome the addiction will cost employers more through their health plan down the road.

Why should benefit plans limit opioid use for wisdom teeth surgeries?

Opioids aren’t the best way to treat pain for this type of surgery because they aren’t actually reducing the pain — only the perception of pain. It’s actually more effective to treat dental pain with over-the-counter ibuprofen and acetaminophen because they reduce inflammation — the actual cause of pain after having these teeth extracted. The euphoria produced by opioids is where addiction comes from. This is a long-standing historical occurrence; people have associated pain relief with euphoria.

These patients shouldn’t consider opioids until they’ve taken non-opioids. Immediately after surgery the anesthetics the patient was on will delay the perception of pain for several hours. If they have breakthrough pain, then I’d consider using opioids, but no longer than three days.

What else can employers do to help prevent young people from getting addicted?

Having a benefit plan that addresses this issue by limiting opioid prescriptions will be the most helpful. But they should also offer support to employees who have a family member going through surgery by sharing information with them about the addiction risks and alternative treatments. Parents may not think of these things unless someone, like their employer, brings it to their attention. They can also share information about signs of addiction and resources for getting help if they suspect a family member is struggling. I think any employee would appreciate knowing their employer is there to support them through difficult situations.

For reprint and licensing requests for this article, click here.
Benefit management Opioid abuse Dental insurance Employee communications