To the Editor The important Original Investigation by Schroeder and colleagues1 that was recently published in JAMA Internal Medicine demonstrates the potential dangers of prescribing immediate-release opioids to a vulnerable population of adolescents and young adults. There are a few facts concerning the surgical removal of third molars that we would like to highlight. The authors state that these teeth normally erupt between the ages of 16 to 25 years. However, the teeth being targeted for surgery are usually impacted and only partially erupted or fully embedded in bone below the soft tissue. The trauma associated with their surgical removal consistently produces moderate to severe pain—the reason the US Food and Drug Administration considers it a pivotal acute pain model in analgesic approval.2 We were surprised that only 2.4% of first prescribers were classified as general surgeons or oral and maxillofacial specialists. Oral surgeons, who have 3 or 4 years of postdoctoral hospital-based training, possess doctor of dental medicine or doctor of dental surgery degrees, as do general dentists, so exactly who the first prescribers were was somewhat confusing. Others have reported that 60% of immediate-release opioid prescriptions are written by oral surgeons.3
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Hersh EV, Saraghi M, Moore PA. Dangers of Opioid Prescribing for Young Adults After Dental Procedures. JAMA Intern Med. 2019;179(7):997–998. doi:10.1001/jamainternmed.2019.0185
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