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Current Drug Safety

Editor-in-Chief

ISSN (Print): 1574-8863
ISSN (Online): 2212-3911

Research Article

Dental Disorders Reported to the FDA Adverse Event Reporting System in Association with Buprenorphine: An Analysis by Ingredient Composition and Route of Administration

Author(s): Richard H. Woods*

Volume 19, Issue 2, 2024

Published on: 09 August, 2023

Page: [261 - 267] Pages: 7

DOI: 10.2174/1574886318666230731151447

Price: $65

Abstract

Background: Prior research has suggested buprenorphine-containing medications may be associated with an increased risk of dental disorders. However, published data describing adverse dental reactions in buprenorphine users by active ingredient composition and route of administration are limited.

Objective: The purpose of this study was to evaluate the influence of formulation on spontaneous reporting of dental disorders among patients treated with buprenorphine.

Methods: Adverse event reports submitted to the United States Food and Drug Administration Adverse Event Reporting System (FAERS) between 2015 and 2022 were analyzed. Reporting odds ratios (ROR) and 95% confidence intervals (CI) were calculated to measure disproportionality of dental disorder reporting as classified by 39 Medical Dictionary for Regulatory Activities preferred terms.

Results: Compared to pooled reports for all other drugs across FAERS, both buprenorphine monotherapy (ROR 3.09; 95% CI 2.61-3.66) and combination buprenorphine/naloxone (ROR 14.61; 95% CI 13.34-16.01) were associated with positive disproportionality signals. Signals of disproportionate dental disorder reporting were also detected for buprenorphine medicines administered by sublingual (ROR 20.03; 95% CI 18.04-22.24), buccal (ROR 4.46; 95% CI 3.00-6.61) and oral (ROR 7.17; 95% CI 5.03-10.22) routes, but not for other modalities. In considering active ingredient and route together, sublingual buprenorphine monotherapies (ROR 23.55; 95% CI 17.84-31.11) and sublingual buprenorphine/naloxone (ROR 19.47; 95% CI 17.39-21.80) were each associated with disproportionate reporting of dental disorders.

Conclusion: Subject to the limitations of spontaneous adverse event data, this study identified significantly disproportionate reporting of dental disorders to FAERS among patients treated with buprenorphine- containing medications, including formulations administered by sublingual, buccal and oral routes. These findings are consistent with prior data and suggest that regular oral care and proper dental hygiene be emphasized for patients undergoing therapy with orally dissolving buprenorphine.

Graphical Abstract

[1]
American Psychiatric Association Diagnostic and statistical manual of mental disorders. (5th ed.), 2013.
[http://dx.doi.org/10.1176/appi.books.9780890425787]
[2]
Keyes KM, Rutherford C, Hamilton A, et al. What is the prevalence of and trend in opioid use disorder in the United States from 2010 to 2019? Using multiplier approaches to estimate prevalence for an unknown population size. Drug Alcohol Depend Rep 2022; 3: 100052.
[http://dx.doi.org/10.1016/j.dadr.2022.100052] [PMID: 35783994]
[3]
Mattson CL, Tanz LJ, Quinn K, Kariisa M, Patel P, Davis NL. Trends and geographic patterns in drug and synthetic opioid overdose deaths—United States, 2013–2019. MMWR Morb Mortal Wkly Rep 2021; 70(6): 202-7.
[http://dx.doi.org/10.15585/mmwr.mm7006a4] [PMID: 33571180]
[4]
Cunningham C, Edlund MJ, Fishman M, et al. The ASAM national practice guideline for the treatment of opioid use disorder: 2020] focused update. J Addict Med 2020; 14(2S) (Suppl. 1): 1-91.
[http://dx.doi.org/10.1097/ADM.0000000000000633] [PMID: 32511106]
[5]
Fareed A, Vayalapalli S, Casarella J, Drexler K. Effect of buprenorphine dose on treatment outcome. J Addict Dis 2012; 31(1): 8-18.
[http://dx.doi.org/10.1080/10550887.2011.642758] [PMID: 22356665]
[6]
Mattick RP, Breen C, Kimber J, Davoli M. Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Libr 2014; 2(2): CD002207.
[http://dx.doi.org/10.1002/14651858.CD002207.pub4] [PMID: 24500948]
[7]
Rosenthal RN, Lofwall MR, Kim S, Chen M, Beebe KL, Vocci FJ. Effect of buprenorphine implants on illicit opioid use among abstinent adults with opioid dependence treated with sublingual buprenorphine. JAMA 2016; 316(3): 282-90.
[http://dx.doi.org/10.1001/jama.2016.9382] [PMID: 27434441]
[8]
Lofwall MR, Walsh SL, Nunes EV, et al. Weekly and monthly subcutaneous buprenorphine depot formulations vs daily sublingual buprenorphine with naloxone for treatment of opioid use disorder. JAMA Intern Med 2018; 178(6): 764-73.
[http://dx.doi.org/10.1001/jamainternmed.2018.1052] [PMID: 29799968]
[9]
Lim J, Farhat I, Douros A, Panagiotoglou D. Relative effectiveness of medications for opioid-related disorders: A systematic review and network meta-analysis of randomized controlled trials. PLoS One 2022; 17(3): e0266142.
[http://dx.doi.org/10.1371/journal.pone.0266142] [PMID: 35358261]
[10]
U.S. Food and Drug Administration. FDA warns about dental problems with buprenorphine medicines dissolved in the mouth to treat opioid use disorder and pain: Benefits for use outweigh these risks and oral care can help 2022. Available from: https://www.fda.gov/media/155352/download Accessed on: Feb 10, 2023
[11]
U.S. Food and Drug Administration FAERS Quarterly data extract files Available from: https://fis.fda.gov/extensions/FPD-QDE-FAERS/FPD-QDE-FAERS.html Accessed on: Feb 10, 2023.
[12]
Poluzzi E, Raschi E, Piccinni C, et al. Data mining techniques in pharmacovigilance: Analysis of the publicly accessible FDA adverse event reporting system (AERS). In: Data Mining Applications in Engineering and Medicine. InTech 2012.
[http://dx.doi.org/10.5772/50095]
[13]
van Puijenbroek EP, Bate A, Leufkens HGM, Lindquist M, Orre R, Egberts ACG. A comparison of measures of disproportionality for signal detection in spontaneous reporting systems for adverse drug reactions. Pharmacoepidemiol Drug Saf 2002; 11(1): 3-10.
[http://dx.doi.org/10.1002/pds.668] [PMID: 11998548]
[14]
Sordo L, Barrio G, Bravo MJ, et al. Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studies. BMJ 2017; 357: j1550.
[http://dx.doi.org/10.1136/bmj.j1550] [PMID: 28446428]
[15]
Wakeman SE, Larochelle MR, Ameli O, et al. Comparative effectiveness of different treatment pathways for opioid use disorder. JAMA Netw Open 2020; 3(2): e1920622.
[http://dx.doi.org/10.1001/jamanetworkopen.2019.20622] [PMID: 32022884]
[16]
Santo T Jr, Clark B, Hickman M, et al. Association of opioid agonist treatment with all-cause mortality and specific causes of death among people with opioid dependence. JAMA Psychiatry 2021; 78(9): 979-93.
[http://dx.doi.org/10.1001/jamapsychiatry.2021.0976] [PMID: 34076676]
[17]
Sun T, Katenka N, Kogut S, Bratberg J, Rich J, Buchanan A. Evaluation of the effectiveness of buprenorphine-naloxone on opioid overdose and death among insured patients with opioid use disorder in the United States. Pharmacoepidemiology 2022; 1(3): 101-12.
[http://dx.doi.org/10.3390/pharma1030010] [PMID: 36743423]
[18]
Suzuki J, Park EM. Buprenorphine/naloxone and dental caries: a case report. Am J Addict 2012; 21(5): 494-5.
[http://dx.doi.org/10.1111/j.1521-0391.2012.00254.x] [PMID: 22882403]
[19]
Suzuki J, Mittal L, Woo SB. Sublingual buprenorphine and dental problems: A case series Prim Care Companion CNS Disord 2013; 15(5): 13l01533.
[http://dx.doi.org/10.4088/PCC.13l01533]
[20]
de Campaigno EP, Kebir I, Montastruc JL, et al. Drug-induced dental caries: A disproportionality analysis using data from vigibase. Drug Saf 2017; 40(12): 1249-58.
[http://dx.doi.org/10.1007/s40264-017-0575-5] [PMID: 28744845]
[21]
Etminan M, Rezaeianzadeh R, Kezouh A, Aminzadeh K. Association between sublingual buprenorphine-naloxone exposure and dental disease. JAMA 2022; 328(22): 2269-71.
[http://dx.doi.org/10.1001/jama.2022.17485] [PMID: 36511932]
[22]
Winstock AR, Lea T, Sheridan J. Patients’ help-seeking behaviours for health problems associated with methadone and buprenorphine treatment. Drug Alcohol Rev 2008; 27(4): 393-7.
[http://dx.doi.org/10.1080/09595230802093745] [PMID: 18584389]
[23]
Abbott PJ. Case Management. Prof Case Manag 2010; 15(3): 145-52.
[http://dx.doi.org/10.1097/NCM.0b013e3181c8c72c] [PMID: 20467277]
[24]
Simon L, Choudhary A, Ticku S, Barrow J, Tobey M. Dental care utilization in Massachusetts before and after initiation of medication for opioid use disorder: A cross‐sectional study of a state all‐payer claims database. J Public Health Dent 2022; 82(4): 461-7.
[http://dx.doi.org/10.1111/jphd.12488] [PMID: 34816438]
[25]
Raschi E, Poluzzi E, Salvo F, et al. Pharmacovigilance of sodium-glucose co-transporter-2 inhibitors: What a clinician should know on disproportionality analysis of spontaneous reporting systems. Nutr Metab Cardiovasc Dis 2018; 28(6): 533-42.
[http://dx.doi.org/10.1016/j.numecd.2018.02.014] [PMID: 29625780]
[26]
D’Amore MM, Cheng DM, Kressin NR, et al. Oral health of substance-dependent individuals: Impact of specific substances. J Subst Abuse Treat 2011; 41(2): 179-85.
[http://dx.doi.org/10.1016/j.jsat.2011.02.005] [PMID: 21474269]

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