Papers of the Week

The United States (US) Department of Veterans Affairs (VA) is the largest integrated health care system in the US and provides dental care to approximately one half million Veterans annually. In response to the opioid crisis, the VA released several opioid risk mitigation strategies. While opioid prescribing by VA dentists have decreased on the whole, the implementation experiences at the level of dentists remains unclear. Our objective was to explore the barriers and facilitators that impact opioid decision-making for management of acute dental pain among VA dentists.Dentists practicing in the VA facilities with the highest and lowest volume of opioid prescriptions were recruited. Standardized qualitative interviews by telephone followed a semi-structured guide designed around the COM-B model. Audio-recordings were transcribed and independently double-coded using NVivo to identify potential targets for future guideline-based opioid interventions. Of 395 eligible general and specialty dentists, 90 (24.8%) completed an interview representing 33 VA facilities. Opportunities for prescribing opioids included: 1) completion of dental procedures associated with acute dental pain, 2) caring for patients who presented with existing dental pain, and 3) responding to patient opioid requests. Capabilities included using resources (e.g. electronic medical records), clinical judgement (e.g. evaluation of medical history including medication use), communication skills, and ability to screen for opioid misuse. Motivation themes focused on alleviating patients' acute dental pain. Barriers and facilitators of opioid prescribing varied across facilities. Results can offer intervention targets for continued opioid risk mitigation efforts.