Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 May 1;277(5):761-766.
doi: 10.1097/SLA.0000000000005193. Epub 2021 Aug 27.

High-risk Opioid Prescribing Associated with Postoperative New Persistent Opioid Use in Adolescents and Young Adults

Gracia M Vargas  1   2 , Vidhya Gunaseelan  2 , Lily Upp  2 , Katherine J Deans  3 , Peter C Minneci  3 , Samir K Gadepalli  1 , Michael J Englesbe  1   2 , Jennifer F Waljee  1   2 , Calista M Harbaugh  1   2
Affiliations

High-risk Opioid Prescribing Associated with Postoperative New Persistent Opioid Use in Adolescents and Young Adults

Gracia M Vargas et al. Ann Surg. .

Abstract

Objective: In this study, we explored which postoperative opioid prescribing practices were associated with persistent opioid use among adolescents and young adults.

Background: Approximately 5% of adolescents and young adults develop postoperative new persistent opioid use. The impact of physician prescribing practices on persistent use among young patients is unknown.

Methods: We identified opioid-naïve patients aged 13 to 21 who underwent 1 of 13 procedures (2008-2016) and filled a perioperative opioid prescription using commercial insurance claims (Optum Deidentified Clinformatics Data Mart Database). Persistent use was defined as ≥ 1 opioid prescription fill 91 to 180 days after surgery. High-risk opioid prescribing included overlapping opioid prescriptions, co-prescribed benzodiazepines, high daily prescribed dosage, long-acting formulations, and multiple prescribers. Logistic regression modeled persistent use as a function of exposure to high-risk prescribing, adjusted for patient demographics, procedure, and comorbidities.

Results: High-risk opioid prescribing practices increased from 34.9% to 43.5% over the study period; the largest increase was in co-prescribed benzodiazepines (24.1%-33.4%). High-risk opioid prescribing was associated with persistent use (aOR 1.235 [1.12,1.36]). Receipt of prescriptions from multiple opioid prescribers was individually associated with persistent use (aOR 1.288 [1.16,1.44]). The majority of opioid prescriptions to patients with persistent use beyond the postoperative period were from nonsurgical prescribers (79.6%).

Conclusions: High-risk opioid prescribing practices, particularly receiving prescriptions from multiple prescribers across specialties, were associated with a significant increase in adolescent and young adult patients' risk of persistent opioid use. Prescription drug monitoring programs may help identify young patients at risk of persistent opioid use.

PubMed Disclaimer

Conflict of interest statement

The authors report no conflicts of interest.

References

    1. Harbaugh CM, Lee JS, Chua KP, et al. Association between long-term opioid use in family members and persistent opioid use after surgery among adolescents and young adults. JAMA Surg. 2020;162(5):746–753.
    1. McCabe SE, West BT, Boyd CJ. Medical use, medical misuse, and nonmedical use of prescription opioids: results from a longitudinal study. Pain. 2013;154:708–713.
    1. Elliott AL, Liu Y, Egan KL, et al. Exposure to medicines in the family medicine cabinet: is it a harbinger of later opioid dependence? Subst Use Misuse. 2020;55:1709–1715.
    1. Brummett CM, Waljee JF, Goesling J, et al. New persistent opioid use after minor and major surgical procedures in US adults. JAMA Surg. 2017;152(6):e170504.
    1. Sun EC, Darnall BD, Baker LC, et al. Incidence of and risk factors for chronic opioid use among opioid-naïve patients in the postoperative period. JAMA Intern Med. 2016;176:1286–1293.