Association between Initial Opioid Prescription and Patient Pain with Continued Opioid Use among Opioid-Naïve Patients Undergoing Elective Surgery in a Large American Health System

Abass Babatunde (), Lior Rennert, Kevin B. Walker, Douglas L. Furmanek, Dawn W. Blackhurst, Vito A. Cancellaro, Alain H. Litwin and Kerry A. Howard ()
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Abass Babatunde: Department of Public Health Sciences, Clemson University, Clemson, SC 29634, USA
Lior Rennert: Department of Public Health Sciences, Clemson University, Clemson, SC 29634, USA
Kevin B. Walker: Prisma Health, Greenville, SC 29605, USA
Douglas L. Furmanek: Prisma Health, Greenville, SC 29605, USA
Dawn W. Blackhurst: Prisma Health, Greenville, SC 29605, USA
Vito A. Cancellaro: Prisma Health, Greenville, SC 29605, USA
Alain H. Litwin: Prisma Health, Greenville, SC 29605, USA
Kerry A. Howard: Department of Public Health Sciences, Clemson University, Clemson, SC 29634, USA

IJERPH, 2023, vol. 20, issue 10, 1-9

Abstract: There is growing concern about the over-prescription of opioids and the risks of long-term use. This study examined the relationship between initial need (pre-operative, post-operative, and discharge pain) and dosage of opioids in the first prescription after surgery with continued opioid use through opioid refills over 12 months, while considering patient-level characteristics. A total of 9262 opioid-naïve patients underwent elective surgery, 7219 of whom were prescribed opioids following surgery. The results showed that 17% of patients received at least one opioid refill within one year post-surgery. Higher initial opioid doses, measured in morphine milligram equivalent (MME), were associated with a greater likelihood of continued use. Patients receiving a dose greater than 90 MME were 1.57 times more likely to receive a refill compared to those receiving less than 90 MME (95% confidence interval: 1.30–1.90, p < 0.001). Additionally, patients who experienced pain before or after surgery were more likely to receive opioid refills. Those experiencing moderate or severe pain were 1.66 times more likely to receive a refill (95% confidence interval: 1.45–1.91, p < 0.001). The findings highlight the need to consider surgery-related factors when prescribing opioids and the importance of developing strategies to balance the optimization of pain management with the risk of opioid-related harms.

Keywords: pre-operative pain; post-operative pain; discharge pain; opioid doses; opioid-naïve; opioid prescription refills; patient-level factors (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2023
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